Provider Demographics
NPI:1407853757
Name:FLEMING, THERESA CATALANO (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:CATALANO
Last Name:FLEMING
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 1:101 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1618
Mailing Address - Country:US
Mailing Address - Phone:856-678-2288
Mailing Address - Fax:856-678-6466
Practice Address - Street 1:101 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1618
Practice Address - Country:US
Practice Address - Phone:856-678-2288
Practice Address - Fax:856-678-6466
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ4130152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147253Medicare PIN
NJU26623Medicare UPIN