Provider Demographics
NPI:1831926609
Name:TOLENTINO, OLIVER THEODORE INES (MSN, NP, AGNP-C)
Entity type:Individual
Prefix:
First Name:OLIVER THEODORE
Middle Name:INES
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:MSN, NP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3447
Mailing Address - Country:US
Mailing Address - Phone:718-304-6306
Mailing Address - Fax:
Practice Address - Street 1:33 OVERLOOK RD. MAC 1
Practice Address - Street 2:SUITE 301
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-522-5045
Practice Address - Fax:908-522-5353
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15150300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner