Provider Demographics
NPI:1285781260
Name:LOVECCHIO, ROSANNA (OD)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:LOVECCHIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90-150 ROUTE 206 NORTH
Mailing Address - Street 2:BYRAM PLAZA
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90-150 ROUTE 206 NORTH
Practice Address - Street 2:BYRAM PLAZA
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874
Practice Address - Country:US
Practice Address - Phone:973-691-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA5045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ694911Medicare ID - Type Unspecified