Healthcare Provider Details

I. General information

NPI: 1053224147
Provider Name (Legal Business Name): ANTHONY MEDVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 BEECHMONT AVE APT 32
CINCINNATI OH
45230-1238
US

IV. Provider business mailing address

2506 BEECHMONT AVE APT 32
CINCINNATI OH
45230-1238
US

V. Phone/Fax

Practice location:
  • Phone: 973-981-1914
  • Fax:
Mailing address:
  • Phone: 973-981-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: