Provider Demographics
NPI:1164440954
Name:ROSANNE VANTUONO MD PA
Entity Type:Organization
Organization Name:ROSANNE VANTUONO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANTUONO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-899-0868
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-0297
Mailing Address - Country:US
Mailing Address - Phone:732-899-0868
Mailing Address - Fax:732-899-5167
Practice Address - Street 1:475 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-458-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05420000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076375Medicare PIN