Healthcare Provider Details

I. General information

NPI: 1487130290
Provider Name (Legal Business Name): ANTHONY NAVARO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ADAMS AVE
SCRANTON PA
18509-1514
US

IV. Provider business mailing address

331 FERNDALE BLVD
ISLIP NY
11751-1916
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6211
  • Fax:
Mailing address:
  • Phone: 631-902-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: