Provider Demographics
NPI:1902814478
Name:ANTOINE, ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:ANTOINE
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:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07019-0770
Mailing Address - Country:US
Mailing Address - Phone:973-674-9100
Mailing Address - Fax:973-674-4007
Practice Address - Street 1:827 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2314
Practice Address - Country:US
Practice Address - Phone:973-674-9100
Practice Address - Fax:973-674-4007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO64371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG38282Medicare UPIN