Provider Demographics
NPI:1558552927
Name:CENTANZO, BARBARA A
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:CENTANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009
Mailing Address - Country:US
Mailing Address - Phone:866-643-4622
Mailing Address - Fax:856-809-1447
Practice Address - Street 1:29 JOHN SINGER SGT WAY
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-7213
Practice Address - Country:US
Practice Address - Phone:866-643-4622
Practice Address - Fax:856-809-1447
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0100 8341 62332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies