Healthcare Provider Details

I. General information

NPI: 1548030240
Provider Name (Legal Business Name): ANTHONY PHILLIP GALZERANO ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 07/18/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W ATLANTIC AVE
HADDON HEIGHTS NJ
08035-1715
US

IV. Provider business mailing address

106 WINTERBERRY WAY
WOODBURY NJ
08096-5558
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-3003
  • Fax:
Mailing address:
  • Phone: 856-982-8426
  • Fax: 856-982-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ14966000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: