Provider Demographics
NPI:1578643961
Name:TORTORICI, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:TORTORICI
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 1:619 RIVER DR
Mailing Address - Street 2:PHILLIPS EYE CENTER
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1317
Mailing Address - Country:US
Mailing Address - Phone:201-796-2020
Mailing Address - Fax:201-796-2833
Practice Address - Street 1:619 RIVER DR
Practice Address - Street 2:PHILLIPS EYE CENTER
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1317
Practice Address - Country:US
Practice Address - Phone:201-796-2020
Practice Address - Fax:201-796-2833
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00554800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
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NJ7680708Medicaid
NJC232G1OtherWELLCHOICE
NJP2522906OtherOXFORD FREEDOM
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NJ0323606000OtherAMERIHEALTH
NJ090005448NJ01OtherANTHEM
NJ2K1488OtherHEALTHNET
NJ5338698OtherAETNA
NJ2K1488OtherHEALTHNET
NJP00010562OtherRAILROAD MEDICARE