Provider Demographics
NPI:1114107786
Name:JOSEPH J ANTINORI
Entity Type:Organization
Organization Name:JOSEPH J ANTINORI
Other - Org Name:BURNSVILLE FAMILY MEDICINE PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTINORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-682-7333
Mailing Address - Street 1:14 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-2902
Mailing Address - Country:US
Mailing Address - Phone:828-682-7333
Mailing Address - Fax:828-682-0392
Practice Address - Street 1:14 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-2902
Practice Address - Country:US
Practice Address - Phone:828-682-7333
Practice Address - Fax:828-682-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134XRMedicaid
NC89134XRMedicaid
NC2351865Medicare PIN