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Mr. Michael Pasquale Derenzo, LDO
Optician in Blackwood, New Jersey
NPI 1114678646

Michael Pasquale Derenzo is a Optician based in Blackwood, NJ and is specialized in Optician. 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 (New Jersey).

The current practice location address for Michael Pasquale Derenzo is 1 Harmon Dr, Blackwood, NJ and can be reached out via phone at 856-228-1000.

Location: 1 Harmon Dr, Blackwood, NJ, 08012-5103
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
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
Fax Number
Provider Enumeration Date
01/17/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
006765 01 NY LICENSED OPTICIAN
institution
Provider Business Practice Location Address Details
Address
1 Harmon Dr
City
Blackwood
State
New Jersey
Zip
08012-5103
Phone Number
856-228-1000
Fax Number
person
Provider Business Mailing Address Details
Address
1 Harmon Dr
City
Blackwood
State
New Jersey
Zip
08012-5103
Phone Number
856-228-1000
Fax Number
person
Provider's Taxonomy Details 1
Type
Eye and Vision Services Providers
Classification
Technician/Technologist
Speciality
Optician
Taxonomy
156FX1800X
License No.
006765 (New York)
Definition
Definition to come...
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