MEDICARE: DR. FRANK DERIENZO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WX0102X	Occupational Vision Optometrist	27OA000470600	NJ
2	152W00000X	Optometrist	TUV004989	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215987888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK DERIENZO OD

Provider Business Mailing Address
First Line	:	123 RIVER DRIVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-222-3937
Fax Number	:	201-798-6021

Provider Business Practice Location Address
First Line	:	123 RIVER DRIVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-222-3937
Fax Number	:	201-798-6021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/19/2019

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Directions to “ DR. FRANK DERIENZO OD” Practice Location

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