Provider Demographics
NPI:1265790752
Name:ANTONIO, EDSEL (DO)
Entity type:Individual
Prefix:DR
First Name:EDSEL
Middle Name:
Last Name:ANTONIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 DURHAM AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2555
Mailing Address - Country:US
Mailing Address - Phone:973-762-7270
Mailing Address - Fax:973-762-1980
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:OB/GYN DEPT
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB09742100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology