Provider Demographics
NPI:1710957998
Name:AVERSA, JAMES JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:AVERSA
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 1:227 1/2 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1901
Mailing Address - Country:US
Mailing Address - Phone:201-288-1109
Mailing Address - Fax:201-288-1589
Practice Address - Street 1:227 1/2 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1901
Practice Address - Country:US
Practice Address - Phone:201-288-1109
Practice Address - Fax:201-288-1589
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00457100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ626422Medicare ID - Type Unspecified
NJU02566Medicare UPIN