Provider Demographics
NPI:1295997765
Name:TRISCHETTA, DONALD G (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:TRISCHETTA
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 1:64 1/2 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2404
Mailing Address - Country:US
Mailing Address - Phone:973-473-1500
Mailing Address - Fax:
Practice Address - Street 1:64 1/2 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2404
Practice Address - Country:US
Practice Address - Phone:973-473-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00123700156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0953500001Medicare NSC