Provider Demographics
NPI:1831235316
Name:BLEICH, JONATHAN MARC
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MARC
Last Name:BLEICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 HIGHWAY 27
Mailing Address - Street 2:SUITE 127
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-940-0900
Mailing Address - Fax:732-940-0735
Practice Address - Street 1:3391 HIGHWAY 27
Practice Address - Street 2:SUITE 127
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823
Practice Address - Country:US
Practice Address - Phone:732-940-0900
Practice Address - Fax:732-940-0735
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00189301156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0953900001Medicare ID - Type Unspecified