Individual provider Active NPI

Robert J Freed, O.D.

  • Optometrist
  • North Bergen, NJ
National Provider Identifier
1083648372
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00360400 Issued in NJ
Practice address
9003 Bergenline Ave
North Bergen, NJ 07047-5235
Phone
(201) 861-0815
Fax
(201) 861-0359
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 27OA00360400 NJ Primary

Addresses

Primary practice location

9003 Bergenline Ave
North Bergen, NJ 07047-5235

Mailing address

9003 Bergenline Ave
North Bergen, NJ 07047-5235
Phone (201) 861-0815

Other identifiers 1

IdentifierTypeStateIssuer
1278207MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
John M. Aljian, MD, PC Past Accepting new patients
David Iosebashvili PC Optometrist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1083648372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9003 BERGENLINE AVE",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475235",
            "telephone_number": "201-861-0815",
            "fax_number": "201-861-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9003 BERGENLINE AVE",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070475235",
            "telephone_number": "201-861-0815",
            "fax_number": "201-861-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREED",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00360400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1278207",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.