Healthcare Provider Details

I. General information

NPI: 1003083510
Provider Name (Legal Business Name): JOSEPH V. CENTOFANTI, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE SUITE 308
CRANSTON RI
02910-4448
US

IV. Provider business mailing address

725 RESERVOIR AVE SUITE 308
CRANSTON RI
02910-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-9559
  • Fax: 401-944-7501
Mailing address:
  • Phone: 401-944-9559
  • Fax: 401-944-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CENTOFANTI
Title or Position: OWNER/NEUROLOGIST
Credential: MD
Phone: 401-944-9559