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General NPI Number Information
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NPI Number | 1083996227
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Entity Type | Organization
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Legal Business Name | VINCENT ANZALONE PHYSICIAN PC
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 847 N BROADWAY SUITE 103
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2373
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Country | US
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Telephone | 516-798-0441
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Fax | 516-798-0445
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Provider Business Mailing Address
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Address Line | 700 HICKSVILLE RD SUITE 200B
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City | BETHPAGE
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State | NY
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Zip | 11714-3471
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Country | US
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Telephone | 516-576-5651
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Fax | 516-576-5820
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VINCENT PETER ANZALONE
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Credential | M.D.
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Telephone | 516-798-0441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 157952
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License Number State | NY
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