Provider Demographics
NPI:1295745859
Name:DEANTONIO, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DEANTONIO
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 914
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-0914
Mailing Address - Country:US
Mailing Address - Phone:609-882-2185
Mailing Address - Fax:609-882-4484
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG 4, SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-882-2185
Practice Address - Fax:609-882-0347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05619900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4515200Medicaid
NJE85122Medicare UPIN
671797Medicare ID - Type Unspecified