NPIMap

Organization Active NPI

Barry J. Edison D.O. P.C.

  • Ophthalmology Physician
  • Eatontown, NJ
National Provider Identifier
1043236185
Registry record updated Nov 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MB72146 Issued in NJ
Legal business name
BARRY J. EDISON D.O. P.C.
Practice address
10 Industrial Way E
Suite 102
Eatontown, NJ 07724-3332
Phone
(732) 542-0300
Fax
(732) 935-0533
NPI assigned
Jul 14, 2006
Last updated
Nov 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barry J. Edison, D.O.NPI 1447283510
Title
Owner
Phone
(732) 542-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X MB72146 NJ Primary

Addresses

Primary practice location

10 Industrial Way E
Suite 102
Eatontown, NJ 07724-3332

Mailing address

10 Industrial Way E
Suite 102
Eatontown, NJ 07724-3332
Phone (732) 542-0300

Other identifiers 1

IdentifierTypeStateIssuer
DF2658OtherNJRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110310000232 NJ Part B Supplier - Clinic/Group Practice 3678522091 Receives reassigned benefits from 6 practitioners
Practice locations: Brick, NJ; Eatontown, NJ

National Provider Directory

National Provider Directory

Locations

10 Industrial Way E
Ste 2
Eatontown, NJ 07724
Phone (732) 542-0300

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321488000000",
    "number": "1043236185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 INDUSTRIAL WAY E",
            "address_2": "SUITE 102",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243332",
            "telephone_number": "732-542-0300",
            "fax_number": "732-935-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 INDUSTRIAL WAY E",
            "address_2": "SUITE 102",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243332",
            "telephone_number": "732-542-0300",
            "fax_number": "732-935-0533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY J. EDISON D.O. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2011-11-17",
        "status": "A",
        "authorized_official_last_name": "EDISON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-542-0300",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "MB72146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF2658",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.