Provider Demographics
NPI:1255387262
Name:DR. S.B. BREGMAN, LLC
Entity type:Organization
Organization Name:DR. S.B. BREGMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BREGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-763-5525
Mailing Address - Street 1:2115 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3724
Mailing Address - Country:US
Mailing Address - Phone:973-763-5525
Mailing Address - Fax:973-763-7541
Practice Address - Street 1:2115 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3724
Practice Address - Country:US
Practice Address - Phone:973-763-5525
Practice Address - Fax:973-763-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1312150001Medicare NSC
NJ175574Medicare PIN