Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 018271 | NY |
N | 103G00000X | Clinical Psychologist | 018271 | NY |
N | 103TC0700X | Clinical Psychologist | 018271 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 018271 | NY |
NPI | 1124346689 |
---|---|
Provider Name | Dr. Anthony J Anzalone |
First Address | Centereach, NY 11720-5601 |
Second Address | Centereach, NY 11720-5601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2010 |
Last Update Date | 16/12/2014 |