Healthcare Provider Details

I. General information

NPI: 1811085392
Provider Name (Legal Business Name): VINCENT P ANZALONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 N BROADWAY SUITE 103
MASSAPEQUA NY
11758-2373
US

IV. Provider business mailing address

79 ASTER STRRET
MASSAPEQUA PARK NY
11762-2373
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-0441
  • Fax: 516-797-8044
Mailing address:
  • Phone: 519-798-0093
  • Fax:

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:
Title or Position:
Credential:
Phone: