Healthcare Provider Details

I. General information

NPI: 1407853757
Provider Name (Legal Business Name): THERESA CATALANO FLEMING O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N BROADWAY
PENNSVILLE NJ
08070-1618
US

IV. Provider business mailing address

101 N BROADWAY
PENNSVILLE NJ
08070-1618
US

V. Phone/Fax

Practice location:
  • Phone: 856-678-2288
  • Fax: 856-678-6466
Mailing address:
  • Phone: 856-678-2288
  • Fax: 856-678-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberNJ4130
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: