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General NPI Number Information
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NPI Number | 1306112164
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Entity Type | Organization
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Legal Business Name | TOLENTINO MEDICAL LLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 401 HAMBURG TPKE SUITE 108
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City | WAYNE
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State | NJ
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Zip | 07470-2154
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Country | US
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Telephone | 973-904-9553
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Fax | 973-904-9274
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Provider Business Mailing Address
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Address Line | 25 HIDEAWAY LANE
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City | SPARTA
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State | NJ
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Zip | 07871
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Country | US
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Telephone | 862-377-4088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELVIRA P. TOLENTINO
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Credential | M.D.
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Telephone | 862-377-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 0400459279
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0400459279
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License Number State | NJ
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