Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 25MA06837000 | NJ |
NPI | 1013913847 |
---|---|
Provider Name | Vincent Abenante |
First Address | Manahawkin, NJ 08050-3392 |
Second Address | Manahawkin, NJ 08050-3392 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 01/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25MA06837000 | LICENSE (01) | NJ |
BA6119451 | DEA (01) |