Healthcare Provider Details

I. General information

NPI: 1053701912
Provider Name (Legal Business Name): ANTHONY VIOLANTE JR. A.S,B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 W PALISADE AVE
ENGLEWOOD NJ
07631-2611
US

IV. Provider business mailing address

93 W PALISADE AVE
ENGLEWOOD NJ
07631-2611
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0500
  • Fax: 201-567-9335
Mailing address:
  • Phone: 201-567-0500
  • Fax: 201-567-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: