Healthcare Provider Details

I. General information

NPI: 1053402818
Provider Name (Legal Business Name): ANTONIO CO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LINCOLN HIGHWAY SUITE 500
EDISON NJ
08820
US

IV. Provider business mailing address

PO BOX 2029 MENLO PARK STATION
EDISON NJ
08818-2029
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-1444
  • Fax:
Mailing address:
  • Phone: 732-494-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMA035841
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1708708
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: