MEDICARE: DR. LAWRENCE J ANASTASI, PA

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	207Q00000X	Family Medicine Physician	646151005	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13532	OTHER	NJ	AETNA US HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	021236602	OTHER	NJ	CIGNA
4	0506248001	OTHER	NJ	AMERIHEALTH
5	3098	OTHER	NJ	AETNA

General Provider Information

NPI Number	:	1922006659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LAWRENCE J ANASTASI, PA

Provider Business Mailing Address
First Line	:	9501 VENTNOR AVE
Second Line	:
City	:	MARGATE CITY
State	:	NJ
Zip	:	08402-2218
Country	:	US
Telephone Number	:	609-823-6161
Fax Number	:	609-823-3413

Provider Business Practice Location Address
First Line	:	9501 VENTNOR AVE
Second Line	:
City	:	MARGATE CITY
State	:	NJ
Zip	:	08402-2218
Country	:	US
Telephone Number	:	609-823-6161
Fax Number	:	609-823-3413

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE J ANASTASI
Credential	:	DO
Telephone Number	:	609-823-6161

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/14/2010

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