Healthcare Provider Details

I. General information

NPI: 1346411006
Provider Name (Legal Business Name): JAMES AVERSA OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 1/2 BLVD.
HASBROUCK HEIGHTS NJ
07604-1901
US

IV. Provider business mailing address

227 1/2 BLVD
HASBROUCK HEIGHTS NJ
07604-1901
US

V. Phone/Fax

Practice location:
  • Phone: 201-288-1109
  • Fax: 201-288-1589
Mailing address:
  • Phone: 201-288-1109
  • Fax: 201-288-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00457100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number27TO00028300
License Number StateNJ

VIII. Authorized Official

Name: DR. JAMES JOHN AVERSA
Title or Position: OPTOMETRIST
Credential: OD
Phone: 201-288-1109