Individual
FRED A PODBIELAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTHALMIC DISPENSER
Contact information
Practice address
701 NEWARK AVE, STE 204, ELIZABETH, NJ 07208-3550
(908) 355-2774
(908) 355-1185
Mailing address
701 NEWARK AVE, STE 204, ELIZABETH, NJ 07208-3550
(908) 355-2774
(908) 355-1185
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
TD-2296
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6777104
—
NJ
Enumeration date
05/23/2007
Last updated
07/09/2007
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