Provider Demographics
NPI:1003882697
Name:SERSANTI, JOHN P (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:SERSANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 PLAZA DR
Mailing Address - Street 2:STE 10
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757
Mailing Address - Country:US
Mailing Address - Phone:732-797-0477
Mailing Address - Fax:732-797-0644
Practice Address - Street 1:3 PLAZA DR
Practice Address - Street 2:STE 10
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757
Practice Address - Country:US
Practice Address - Phone:732-797-0477
Practice Address - Fax:732-797-0644
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA2507155600207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
087190Medicare ID - Type Unspecified
NJ087190Medicare PIN
043701TQMMedicare ID - Type Unspecified
NJH28284Medicare UPIN