Provider Demographics
NPI:1154360543
Name:CENTOFANTI, JOSEPH V
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:CENTOFANTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RESERVOIR AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-9559
Mailing Address - Fax:401-944-7501
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-944-9559
Practice Address - Fax:401-944-7501
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08551174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5529810001Medicare NSC