Provider Demographics
NPI:1568617330
Name:ALESSANDRA BERTOLUCCI MD LLC
Entity Type:Organization
Organization Name:ALESSANDRA BERTOLUCCI MD LLC
Other - Org Name:ASSOCIATED EYE PHYSICANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALESSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-472-6405
Mailing Address - Street 1:1033 CLIFTON AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-773-9882
Mailing Address - Fax:973-773-9883
Practice Address - Street 1:1033 CLIFTON AVE STE 107
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-472-6405
Practice Address - Fax:973-472-6406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07279200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ144450Medicare PIN