Provider Demographics
NPI:1720160427
Name:PANTIN, ENRIQUE J (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:J
Last Name:PANTIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 NW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1755
Mailing Address - Country:US
Mailing Address - Phone:732-890-0640
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-937-8841
Practice Address - Fax:732-418-8492
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07011300207L00000X, 207LP3000X
FLME95741207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8421901Medicaid
NJH30867Medicare UPIN
NJ045018A01Medicare PIN