Healthcare Provider Details

I. General information

NPI: 1164440954
Provider Name (Legal Business Name): ROSANNE VANTUONO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

IV. Provider business mailing address

PO BOX 297
MANASQUAN NJ
08736-0297
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-6600
  • Fax:
Mailing address:
  • Phone: 732-899-0868
  • Fax: 732-899-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA05420000
License Number StateNJ

VIII. Authorized Official

Name: ROSANNE VANTUONO
Title or Position: OWNER
Credential: MD
Phone: 732-899-0868