Provider Demographics
NPI:1013913847
Name:ABENANTE, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:ABENANTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 E BAY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3392
Mailing Address - Country:US
Mailing Address - Phone:609-489-0220
Mailing Address - Fax:609-489-0228
Practice Address - Street 1:588 E BAY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3392
Practice Address - Country:US
Practice Address - Phone:609-489-0220
Practice Address - Fax:609-489-0228
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06837000207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06837000OtherLICENSE
BA6119451OtherDEA
BA6119451OtherDEA