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General NPI Number Information
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NPI Number | 1578750345
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Entity Type | Organization
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Legal Business Name | MARK NITTI OD & STEVEN RENNER OD,PA
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 1025 W SAINT GEORGES AVE
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City | LINDEN
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State | NJ
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Zip | 07036-6134
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Country | US
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Telephone | 908-486-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 W SAINT GEORGES AVE
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City | LINDEN
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State | NJ
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Zip | 07036-6134
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Country | US
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Telephone | 908-486-5050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN RENNER
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Credential | OD
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Telephone | 908-486-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4532
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License Number State | NJ
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