Healthcare Provider Details

I. General information

NPI: 1831187780
Provider Name (Legal Business Name): CHARLES H ANTINORI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E CHESTNUT AVE
VINELAND NJ
08360-5002
US

IV. Provider business mailing address

2848 S DELSEA DR SUITE 4B
VINELAND NJ
08360-7042
US

V. Phone/Fax

Practice location:
  • Phone: 856-213-6375
  • Fax: 856-575-4986
Mailing address:
  • Phone: 856-205-7070
  • Fax: 856-205-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA03721000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: