Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MAO42475 | NJ |
NPI | 1124071857 |
---|---|
Provider Name | Dr. Anthony Anzalone |
First Address | Cranford, NJ 07016-3223 |
Second Address | Clifton, NJ 07012-1344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 23/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B16479 | (02) | NJ |