Provider Demographics
NPI:1467551374
Name:HATZANTONIS, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:HATZANTONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4100
Mailing Address - Country:US
Mailing Address - Phone:856-455-4800
Mailing Address - Fax:856-453-1450
Practice Address - Street 1:201 LAUREL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3635
Practice Address - Country:US
Practice Address - Phone:856-455-4800
Practice Address - Fax:856-453-1450
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8899401Medicaid
NJF63324Medicare UPIN
NJ057217A2PMedicare ID - Type Unspecified