Healthcare Provider Details

I. General information

NPI: 1003843905
Provider Name (Legal Business Name): ANTHONY ALTOBELLI III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 CRANBURY RD SUITE 2
EAST BRUNSWICK NJ
08816-4093
US

IV. Provider business mailing address

593 CRANBURY RD SUITE 2
EAST BRUNSWICK NJ
08816-4093
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-3333
  • Fax: 732-390-9244
Mailing address:
  • Phone: 732-390-3333
  • Fax: 732-390-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07586700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA07586700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA07586700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: