Mr. Michael P Derenzo, LDO
Technician/Technologist, Optician in Blackwood, New Jersey
1114678646- Practice location
- 1 Harmon Dr, Blackwood, NJ 08012-5103
- Phone
- 856-228-1000
- Fax
- —
- Last updated
- January 17, 2022
Michael Pasquale Derenzo is a Technician/Technologist, Optician based in Blackwood, NJ. Michael Pasquale Derenzo practices in Blackwood, NJ and has the professional credentials of LDO. The NPI Number for Michael Pasquale Derenzo is 1114678646 and holds a License No. 006765 (NY). The current practice location address for Michael Pasquale Derenzo is 1 Harmon Dr, Blackwood, NJ 08012-5103 and can be reached out via phone at 856-228-1000.
Provider Profile Details
- NPI Number
- 1114678646
- Provider Name
- Michael Pasquale Derenzo
- Credential
- LDO
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 1 Harmon Dr, Blackwood, NJ 08012-5103
- Phone Number
- 856-228-1000
- Primary Taxonomy
- Technician/Technologist, Optician · 156FX1800X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- January 17, 2022
- Last Update Date
- January 17, 2022
- Certification Date
- January 17, 2022
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1 Harmon Dr
Blackwood, NJ 08012-5103 - City
- Blackwood
- State
- New Jersey
- Zip
- 08012-5103
- Phone Number
- 856-228-1000
Provider Business Mailing Address Details
- Address
- 1 Harmon Dr
Blackwood, NJ 08012-5103 - City
- Blackwood
- State
- NJ
- Zip
- 08012-5103
- Phone Number
- 856-228-1000
License Information
- License Number
- 006765
- License State
- NY
- Taxonomy
- Technician/Technologist, Optician · 156FX1800X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mr. Michael P Derenzo, LDO?
The NPI number of Mr. Michael P Derenzo, LDO is 1114678646. It was assigned on January 17, 2022 and is currently active in the NPPES registry.
What is the specialty of Mr. Michael P Derenzo, LDO?
Mr. Michael P Derenzo, LDO is registered under the primary taxonomy Technician/Technologist, Optician (code 156FX1800X), licensed in NY under license number 006765.
Where does Mr. Michael P Derenzo, LDO practice?
The practice location is 1 Harmon Dr, Blackwood, NJ 08012-5103. The office can be reached at 856-228-1000 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1114678646 directly on the NPPES registry website.