Provider Demographics
NPI:1396783544
Name:BEJA, EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:BEJA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1623
Mailing Address - Country:US
Mailing Address - Phone:201-666-3566
Mailing Address - Fax:
Practice Address - Street 1:330A BROADWAY
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1417
Practice Address - Country:US
Practice Address - Phone:201-666-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ005141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU37240Medicare UPIN
NJ529944VMWMedicare PIN