Healthcare Provider Details

I. General information

NPI: 1285781260
Provider Name (Legal Business Name): ROSANNA LOVECCHIO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90-150 ROUTE 206 NORTH BYRAM PLAZA
STANHOPE NJ
07874
US

IV. Provider business mailing address

90-150 ROUTE 206 NORTH BYRAM PLAZA
STANHOPE NJ
07874
US

V. Phone/Fax

Practice location:
  • Phone: 973-691-8840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA5045
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: