Provider Demographics
NPI:1972987618
Name:CUSENZA, CHELSEA (OD)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:CUSENZA
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 1:33 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2167
Mailing Address - Country:US
Mailing Address - Phone:201-438-4418
Mailing Address - Fax:
Practice Address - Street 1:33 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2167
Practice Address - Country:US
Practice Address - Phone:201-438-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00660800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist