Healthcare Provider Details

I. General information

NPI: 1316866163
Provider Name (Legal Business Name): VICTORIA ROSE BASCIANO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MORRIS TPKE
SHORT HILLS NJ
07078-2746
US

IV. Provider business mailing address

11 BANCROFT AVE
STATEN ISLAND NY
10306-2405
US

V. Phone/Fax

Practice location:
  • Phone: 973-535-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00744800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: