Provider Demographics
NPI:1154321800
Name:ANTARIO, JOSEPH M (UROLOGIST)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:ANTARIO
Suffix:
Gender:M
Credentials:UROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1535
Mailing Address - Country:US
Mailing Address - Phone:908-387-9207
Mailing Address - Fax:908-387-9311
Practice Address - Street 1:388 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1535
Practice Address - Country:US
Practice Address - Phone:908-387-9207
Practice Address - Fax:908-387-9311
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2016-03-02
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
PAMD051575L174400000X
NJ25MA06029500174400000X
NY1741381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001501467003Medicaid
PA001501467004Medicaid
NJ78025421057300OtherHORIZON OF NJ
PA001501467004Medicaid
NJ78025421057300OtherHORIZON OF NJ
NJ073317Medicare ID - Type Unspecified
NJD20674Medicare UPIN