Provider Demographics
NPI:1740348572
Name:LOSURDO, CARMELA (OD)
Entity type:Individual
Prefix:DR
First Name:CARMELA
Middle Name:
Last Name:LOSURDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2973
Mailing Address - Country:US
Mailing Address - Phone:201-621-1459
Mailing Address - Fax:
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00598702152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084875Medicaid
NJ096537Medicare ID - Type UnspecifiedOPTOMETRY