MEDICARE: MARK NITTI OD & STEVEN RENNER 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	152W00000X	Optometrist	4532	NJ

General Provider Information

NPI Number	:	1578750345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK NITTI OD & STEVEN RENNER OD,PA

Provider Business Mailing Address
First Line	:	1025 W SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-486-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 W SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-486-5050
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN RENNER
Credential	:	OD
Telephone Number	:	908-486-5050

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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