Provider Demographics
NPI:1104927920
Name:GRAFILO, ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:GRAFILO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WEST FATHER KEIS DRIVE
Mailing Address - Street 2:BOX 710
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0000
Mailing Address - Country:US
Mailing Address - Phone:609-965-4858
Mailing Address - Fax:609-965-4859
Practice Address - Street 1:252 WEST FATHER KEIS DRIVE
Practice Address - Street 2:BOX 710
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0000
Practice Address - Country:US
Practice Address - Phone:609-965-4858
Practice Address - Fax:609-965-4859
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03012500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1395408Medicaid
NJ503129Medicare PIN
C52859Medicare UPIN