Provider Demographics
NPI:1104989797
Name:ROBERT B BREEDEN OD RONALD J MINSKY OD PA
Entity type:Organization
Organization Name:ROBERT B BREEDEN OD RONALD J MINSKY OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-389-6512
Mailing Address - Street 1:255 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2169
Mailing Address - Country:US
Mailing Address - Phone:732-389-6512
Mailing Address - Fax:732-389-0585
Practice Address - Street 1:255 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2169
Practice Address - Country:US
Practice Address - Phone:732-389-6512
Practice Address - Fax:732-389-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA003420152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521348Medicare ID - Type Unspecified