Healthcare Provider Details

I. General information

NPI: 1982670089
Provider Name (Legal Business Name): ANTHONY J MSTELLONE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 89TH AVE
JAMAICA NY
11432-3730
US

IV. Provider business mailing address

12 HILLTOP LN
OYSTER BAY NY
11771-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-2072
  • Fax:
Mailing address:
  • Phone: 718-558-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number119240
License Number StateNY

VIII. Authorized Official

Name: ANTHONY J MASTELLONE
Title or Position: PRESIDENT
Credential: MD
Phone: 718-558-2072