Provider Demographics
NPI:1467590893
Name:RUSIGNUOLO, ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:RUSIGNUOLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FRANKLIN PL
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1707
Mailing Address - Country:US
Mailing Address - Phone:201-933-2576
Mailing Address - Fax:201-933-2602
Practice Address - Street 1:15 FRANKLIN PL
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1707
Practice Address - Country:US
Practice Address - Phone:201-933-2576
Practice Address - Fax:201-933-2602
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007066152W00000X
NJ27OA00625300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03110776Medicaid