Provider Demographics
NPI:1730297169
Name:TREZZA, ANTHONY (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:TREZZA
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 1:5 E MAIN ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2175
Mailing Address - Country:US
Mailing Address - Phone:973-983-0400
Mailing Address - Fax:973-215-2122
Practice Address - Street 1:5 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2175
Practice Address - Country:US
Practice Address - Phone:973-983-0400
Practice Address - Fax:973-215-2122
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ5208152W00000X
NJTPANJ0495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147886Medicare PIN
NJDT0952Medicare PIN