Provider Demographics
NPI:1871787028
Name:TROTTINI, MICHAEL R (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:TROTTINI
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 CENTRE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1864
Mailing Address - Country:US
Mailing Address - Phone:609-409-2777
Mailing Address - Fax:609-409-2718
Practice Address - Street 1:5 CENTRE DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1864
Practice Address - Country:US
Practice Address - Phone:609-409-2777
Practice Address - Fax:609-409-2718
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2069152W00000X
NJ270A0644500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD616LR796Medicare PIN
MD91539901OtherCAREFIRST BLUESHIELD
MD413493100Medicaid
MDW2450006OtherBLUESHIELD NCA
MD617LR797Medicare PIN