Provider Demographics
NPI:1629016431
Name:MONTELEONE, ANTHONY (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MONTELEONE
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 1:1302 N DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2278
Mailing Address - Country:US
Mailing Address - Phone:856-696-3904
Mailing Address - Fax:856-696-8333
Practice Address - Street 1:1302 N DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2278
Practice Address - Country:US
Practice Address - Phone:856-696-3904
Practice Address - Fax:856-696-8333
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00473100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ329460901Medicaid
NJ2143602000OtherAMERIHEALTH
NJFH2099325OtherFIRST HEALTH
NJ222739868OtherHORIZON
NJ35517OtherAETNA
NJ35517OtherAETNA
NJ329460901Medicaid