Provider Demographics
NPI:1588190656
Name:NUTLEY VISION
Entity Type:Organization
Organization Name:NUTLEY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITENZON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:862-208-2245
Mailing Address - Street 1:214 FRANKLIN AVE.
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110
Mailing Address - Country:US
Mailing Address - Phone:862-208-2245
Mailing Address - Fax:862-208-2245
Practice Address - Street 1:214 FRANKLIN AVE.
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110
Practice Address - Country:US
Practice Address - Phone:862-208-2245
Practice Address - Fax:862-208-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00592900332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV05707Medicare UPIN
NJ092682Medicare PIN