Basic Information
| Provider Information | |||||||||
| NPI: | 1548609464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FANTINI | ||||||||
| FirstName: | DOMENICA | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAPARATTO | ||||||||
| OtherFirstName: | DOMENICA | ||||||||
| OtherMiddleName: | ALEXANDRA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 95000 LB# 7550 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191957550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 MARTINSVILLE RD | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | BASKING RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079204700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086071877 | ||||||||
| FaxNumber: | 9086071866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 02/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB09772000 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.