1083996227 NPI number — VINCENT ANZALONE PHYSICIAN PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083996227 NPI number — VINCENT ANZALONE PHYSICIAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINCENT ANZALONE PHYSICIAN PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083996227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 HICKSVILLE RD
Provider Second Line Business Mailing Address:
SUITE 200B
Provider Business Mailing Address City Name:
BETHPAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11714-3471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-576-5651
Provider Business Mailing Address Fax Number:
516-576-5820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
847 N BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-798-0441
Provider Business Practice Location Address Fax Number:
516-798-0445
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ANZALONE
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-798-0441

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  157952 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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