MEDICARE: TONI V CENTANNI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	25MA04837600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0104214000	OTHER	NJ	AMERIHEALTH
2	PP057	OTHER	NJ	OXFORD
3	2K2465	OTHER	NJ	HEALTHNET

General Provider Information

NPI Number	:	1700832649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI V CENTANNI M.D.

Provider Business Mailing Address
First Line	:	330 RATZER RD
Second Line	:	STE.#7
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-694-2222
Fax Number	:	973-694-7664

Provider Business Practice Location Address
First Line	:	330 RATZER RD
Second Line	:	STE.#7
City	:	WAYNE
State	:	NJ
Zip	:	07470-7702
Country	:	US
Telephone Number	:	973-694-2222
Fax Number	:	973-694-7664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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