Provider Demographics
NPI:1982848271
Name:CORPORA, DENNIS ANTHONY (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:CORPORA
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 EXCHANGE PLACE
Mailing Address - Street 2:HARBORSIDE FINANCIAL CENTER PLAZA II
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311
Mailing Address - Country:US
Mailing Address - Phone:201-946-9100
Mailing Address - Fax:
Practice Address - Street 1:34 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3885
Practice Address - Country:US
Practice Address - Phone:201-946-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00204000156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician