MEDICARE: JAMES AVERSA OD PA

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	332BC3200X	Customized Equipment (DME)	27TO00028300	NJ
2	152W00000X	Optometrist	27OA00457100	NJ

General Provider Information

NPI Number	:	1346411006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES AVERSA OD PA

Provider Business Mailing Address
First Line	:	227 1/2 BLVD
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1901
Country	:	US
Telephone Number	:	201-288-1109
Fax Number	:	201-288-1589

Provider Business Practice Location Address
First Line	:	227 1/2 BLVD.
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1901
Country	:	US
Telephone Number	:	201-288-1109
Fax Number	:	201-288-1589

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. JAMES JOHN AVERSA
Credential	:	OD
Telephone Number	:	201-288-1109

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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