Provider Demographics
NPI:1972743698
Name:ANTONIO, ANGELITO (NP-C)
Entity type:Individual
Prefix:MR
First Name:ANGELITO
Middle Name:
Last Name:ANTONIO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2900
Mailing Address - Country:US
Mailing Address - Phone:973-696-3868
Mailing Address - Fax:
Practice Address - Street 1:930 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-696-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00260500364SA2200X, 364SG0600X, 363LP2300X
NYF305268-1364SA2200X
NYF340760-1364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology