Healthcare Provider Details

I. General information

NPI: 1508991811
Provider Name (Legal Business Name): ANTHONY R. DIPASTINA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 US HIGHWAY 1
LAWRENCEVILLE NJ
08648-4407
US

IV. Provider business mailing address

PO BOX 55845
TRENTON NJ
08638-6845
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-5111
  • Fax: 609-394-8242
Mailing address:
  • Phone: 609-394-5111
  • Fax: 609-394-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC02210
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: