Provider Demographics
NPI:1134327430
Name:ATTANASIO, ANGELO CHARLES
Entity Type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:CHARLES
Last Name:ATTANASIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 101 MEP DIVISION
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1288
Mailing Address - Country:US
Mailing Address - Phone:609-588-6000
Mailing Address - Fax:
Practice Address - Street 1:3705 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 101 MEP DIVISION
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1288
Practice Address - Country:US
Practice Address - Phone:609-588-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01447000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist