Healthcare Provider Details

I. General information

NPI: 1003065392
Provider Name (Legal Business Name): ANTHONY SANTORO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 AMBOY AVE
METUCHEN NJ
08840-2440
US

IV. Provider business mailing address

216 AMBOY AVE
METUCHEN NJ
08840-2440
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-1353
  • Fax: 732-906-6405
Mailing address:
  • Phone: 732-494-1353
  • Fax: 732-906-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA02147800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA021478
License Number StateNJ

VIII. Authorized Official

Name: DR. ANTHONY FRANCIS SANTORO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 732-494-1353