Provider Demographics
NPI:1518978816
Name:TOLENTINO, MILAGROS PAUNAN (MD)
Entity Type:Individual
Prefix:MISS
First Name:MILAGROS
Middle Name:PAUNAN
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MILAGROS
Other - Middle Name:TOLENTINO
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25 PORSCHE DR
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3538
Mailing Address - Country:US
Mailing Address - Phone:732-583-2813
Mailing Address - Fax:
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:NEWARK BETH ISRAEL MED. CTR.
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037709002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6278302Medicaid
NJ6278302Medicaid