Healthcare Provider Details

I. General information

NPI: 1922192517
Provider Name (Legal Business Name): ANTOINETTE DEINGENIIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 KINNELON RD STE K
KINNELON NJ
07405-2337
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-4671
US

V. Phone/Fax

Practice location:
  • Phone: 973-829-4080
  • Fax:
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 NumberMB062767
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: