Individual
MR. MICHAEL PASQUALE DERENZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
1 HARMON DR, BLACKWOOD, NJ 08012-5103
(856) 228-1000
Mailing address
1 HARMON DR, BLACKWOOD, NJ 08012-5103
(856) 228-1000
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
006765
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006765
LICENSED OPTICIAN
NY
Enumeration date
01/17/2022
Last updated
01/17/2022
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