NPIMap

Organization Active NPI

Freehold Ophthalmology, LLC

  • Ophthalmology Physician
  • Freehold, NJ
National Provider Identifier
1861446932
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
25MA07781000 Issued in NJ
Legal business name
FREEHOLD OPHTHALMOLOGY, LLC
Practice address
509 Stillwells Corner Rd Ste E5
Freehold, NJ 07728-2965
Phone
(732) 431-9333
Fax
(732) 431-3312
NPI assigned
May 21, 2006
Last updated
Oct 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

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

Authorized official

Name
Dr. Eric Andrew Gershenbaum, MDNPI 1548227309
Title
Owner
Phone
(732) 431-9333

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 25MA07781000 NJ Primary

Addresses

Primary practice location

509 Stillwells Corner Rd Ste E5
Freehold, NJ 07728-2965

Mailing address

509 Stillwells Corner Rd
Suite E5
Freehold, NJ 07728-2965
Phone (732) 431-9333

Other identifiers 1

IdentifierTypeStateIssuer
0053023MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041208000433 NJ Part B Supplier - Clinic/Group Practice 9335105691 Receives reassigned benefits from 17 practitioners
Practice locations: Brick, NJ; Toms River, NJ; Manalapan, NJ; Howell, NJ; Holmdel, NJ; Freehold, NJ; Burlington, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2024479Freehold Ophthalmology509 Stillwells Corner Road, Suite E 5, Freehold, NJ 07728Certificate of waiverDec 20, 2027

National Provider Directory

National Provider Directory

Locations

202 Jack Martin Blvd
Unit C4
Brick, NJ 08724
Phone (732) 458-5700

990 Cedar Bridge Ave
Ste B19
Brick, NJ 08723

509 Stillwells Corner Rd
Ste E5
Freehold, NJ 07728
Phone (732) 409-6440

2145 State Route 35
Ste 22
Holmdel, NJ 07733
Phone (732) 264-9494

911 Oak Tree Ave
South Plainfield, NJ 07080
Phone (908) 822-1100

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1148169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1861446932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 STILLWELLS CORNER RD",
            "address_2": "SUITE E5",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282965",
            "telephone_number": "732-431-9333",
            "fax_number": "732-431-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 STILLWELLS CORNER RD STE E5",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077282965",
            "telephone_number": "732-431-9333",
            "fax_number": "732-431-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEHOLD OPHTHALMOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-21",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "GERSHENBAUM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-431-9333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "25MA07781000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0053023",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.