Healthcare Provider Details

I. General information

NPI: 1548609464
Provider Name (Legal Business Name): DOMENICA ALEXANDRA FANTINI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOMENICA ALEXANDRA PAPARATTO D.O.

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 MARTINSVILLE RD SUITE 218
BASKING RIDGE NJ
07920-4700
US

IV. Provider business mailing address

PO BOX 95000 LB# 7550
PHILADELPHIA PA
19195-7550
US

V. Phone/Fax

Practice location:
  • Phone: 908-607-1877
  • Fax: 908-607-1866
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB09772000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: