Healthcare Provider Details

I. General information

NPI: 1083996227
Provider Name (Legal Business Name): VINCENT ANZALONE PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 N BROADWAY SUITE 103
MASSAPEQUA NY
11758-2373
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 200B
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-0441
  • Fax: 516-798-0445
Mailing address:
  • Phone: 516-576-5651
  • Fax: 516-576-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number157952
License Number StateNY

VIII. Authorized Official

Name: DR. VINCENT PETER ANZALONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-798-0441