Provider Demographics
NPI:1003083510
Name:JOSEPH V. CENTOFANTI, MD
Entity Type:Organization
Organization Name:JOSEPH V. CENTOFANTI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTOFANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-944-9559
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI5529810001Medicare NSC
RI709006149Medicare PIN