Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 182035 | NY |
NPI | 1053325357 |
---|---|
Provider Name | Anthony Paul Vastola |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Brooklyn, NY 11201-2701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 04/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1511839 | (05) | NY |
BV4021022 | DEA (01) | NY |