Provider Demographics
NPI:1396808143
Name:TOLENTINO, ERNESTO A (MD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:A
Last Name:TOLENTINO
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 1:600 PAVONIO AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-216-9300
Mailing Address - Fax:201-216-0091
Practice Address - Street 1:600 PAVONIO AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-216-9300
Practice Address - Fax:201-216-0091
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2785609Medicaid
113909000OtherUS DEPT OF LABOR
E10278Medicare UPIN
NJ064776Medicare ID - Type Unspecified