Basic Information
Provider Information | |||||||||
NPI: | 1083996227 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VINCENT ANZALONE PHYSICIAN PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 700 HICKSVILLE RD | ||||||||
Address2: | SUITE 200B | ||||||||
City: | BETHPAGE | ||||||||
State: | NY | ||||||||
PostalCode: | 117143471 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5165765651 | ||||||||
FaxNumber: | 5165765820 | ||||||||
Practice Location | |||||||||
Address1: | 847 N BROADWAY | ||||||||
Address2: | SUITE 103 | ||||||||
City: | MASSAPEQUA | ||||||||
State: | NY | ||||||||
PostalCode: | 117582373 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5167980441 | ||||||||
FaxNumber: | 5167980445 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/14/2011 | ||||||||
LastUpdateDate: | 09/14/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ANZALONE | ||||||||
AuthorizedOfficialFirstName: | VINCENT | ||||||||
AuthorizedOfficialMiddleName: | PETER | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5167980441 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 157952 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.