Provider Demographics
NPI:1891782843
Name:COVUCCI, AMY L
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:COVUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2794
Mailing Address - Country:US
Mailing Address - Phone:973-579-3937
Mailing Address - Fax:973-579-9825
Practice Address - Street 1:11 LAWRENCE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2794
Practice Address - Country:US
Practice Address - Phone:973-579-3937
Practice Address - Fax:973-579-9825
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 05593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ5593OtherEYEMED
NH043601321OtherQUALCARE
NJP2524564OtherOXFORD
NJ043601321OtherBLUE CROSS/BLUESHIELD
NJ2275569OtherUNITED HEALTHCARE
NJ2K2438OtherHEALTHNET
NJ3381874OtherCIGNA
NJ2832276OtherAETNA
NJ2K2438OtherHEALTHNET
NJV83513Medicare UPIN