Provider Demographics
NPI:1396497475
Name:DI ANTONIO, VINCENT L (RN, CRNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:L
Last Name:DI ANTONIO
Suffix:
Gender:M
Credentials:RN, CRNP, PMHNP-BC
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 985
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-0985
Mailing Address - Country:US
Mailing Address - Phone:215-650-7855
Mailing Address - Fax:
Practice Address - Street 1:714 E MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3068
Practice Address - Country:US
Practice Address - Phone:856-391-0032
Practice Address - Fax:856-249-9651
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026135363LP0808X
PARN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health