Healthcare Provider Details

I. General information

NPI: 1255794269
Provider Name (Legal Business Name): JOHN PAUL ANAGNOSTAKOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BROAD ST
CLIFTON NJ
07013-4236
US

IV. Provider business mailing address

673 MORRIS AVE STE 201
SPRINGFIELD NJ
07081-1512
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-9000
  • Fax:
Mailing address:
  • Phone: 973-759-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA12562300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: