MEDICARE: DR. CHELSEA CUSENZA O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00660800	NJ

General Provider Information

NPI Number	:	1972987618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHELSEA CUSENZA O.D

Provider Business Mailing Address
First Line	:	33 LINCOLN AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-438-4418
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 LINCOLN AVE
Second Line	:
City	:	RUTHERFORD
State	:	NJ
Zip	:	07070-2167
Country	:	US
Telephone Number	:	201-438-4418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	03/27/2018

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