=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700832649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONI V CENTANNI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 RATZER RD STE.#7
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-7702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-694-2222
-----------------------------------------------------
Fax | 973-694-7664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 RATZER RD STE.#7
-----------------------------------------------------
City | WAYNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07470-7702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-694-2222
-----------------------------------------------------
Fax | 973-694-7664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 25MA04837600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------