Healthcare Provider Details

I. General information

NPI: 1760068910
Provider Name (Legal Business Name): VINCENT R TOLENTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 2ND AVE
HASKELL NJ
07420-1109
US

IV. Provider business mailing address

173 ALPS RD
WAYNE NJ
07470-6024
US

V. Phone/Fax

Practice location:
  • Phone: 973-519-1996
  • Fax:
Mailing address:
  • Phone: 973-519-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP06590700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: