Healthcare Provider Details

I. General information

NPI: 1861742579
Provider Name (Legal Business Name): ANTHONY PACIONE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2736
US

IV. Provider business mailing address

1 SEARS DR STE 306
PARAMUS NJ
07652-3510
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax: 201-447-8019
Mailing address:
  • Phone: 201-830-2287
  • Fax: 201-830-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00427900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: