Provider Demographics
NPI:1053518613
Name:GREEN BROOK VISION ASSOCIATES INC
Entity type:Organization
Organization Name:GREEN BROOK VISION ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-356-3060
Mailing Address - Street 1:328 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2200
Mailing Address - Country:US
Mailing Address - Phone:732-356-3060
Mailing Address - Fax:732-805-3032
Practice Address - Street 1:328 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2200
Practice Address - Country:US
Practice Address - Phone:732-356-3060
Practice Address - Fax:732-805-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00129802156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6007440001Medicare PIN