MEDICARE: ANTHONY PAUL VASTOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	182035	NY
2	207Y00000X	Otolaryngology Physician	182035	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053325357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY PAUL VASTOLA MD

Provider Business Mailing Address
First Line	:	660 WHITE PLAINS RD FL 4
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5139
Country	:	US
Telephone Number	:	914-984-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CADMAN PLZ W
Second Line	:	SUITE 1301
City	:	BROOKLYN
State	:	NY
Zip	:	11201-2701
Country	:	US
Telephone Number	:	929-252-1566
Fax Number	:	718-208-4663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/08/2024

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