Provider Demographics
NPI:1841405008
Name:PANTANO, MARIA VITA (DO)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VITA
Last Name:PANTANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075
Mailing Address - Country:US
Mailing Address - Phone:201-438-5500
Mailing Address - Fax:201-438-3363
Practice Address - Street 1:245 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075
Practice Address - Country:US
Practice Address - Phone:201-438-5500
Practice Address - Fax:201-438-3363
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00000000000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine