Provider Demographics
NPI:1326246133
Name:ERNESTO TOLENTINO MD & HENRY C IRVING MD, PA
Entity Type:Organization
Organization Name:ERNESTO TOLENTINO MD & HENRY C IRVING MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-216-9300
Mailing Address - Street 1:600 PAVONIA AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2929
Mailing Address - Country:US
Mailing Address - Phone:201-216-9300
Mailing Address - Fax:201-216-0091
Practice Address - Street 1:600 PAVONIA AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2929
Practice Address - Country:US
Practice Address - Phone:201-216-9300
Practice Address - Fax:201-216-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
113909000OtherUS DOL
NJ2785609Medicaid
NJ459148Medicare ID - Type Unspecified