Provider Demographics
NPI:1063241644
Name:AQUINO INFUSION PA
Entity type:Organization
Organization Name:AQUINO INFUSION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-732-1818
Mailing Address - Street 1:6274 LINTON BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6508
Mailing Address - Country:US
Mailing Address - Phone:561-559-9800
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2555
Practice Address - Country:US
Practice Address - Phone:732-962-9800
Practice Address - Fax:732-962-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy