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General NPI Number Information
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NPI Number | 1366483174
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Entity Type | Individual
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Provider Name | ATHOS C ANASTASIADES MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 62 RIDGE RD
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City | NORTH ARLINGTON
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State | NJ
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Zip | 07031-6318
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Country | US
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Telephone | 201-991-8565
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Fax | 201-991-2408
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Provider Business Mailing Address
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Address Line | 62 RIDGE RD
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City | NORTH ARLINGTON
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State | NJ
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Zip | 07031-6318
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Country | US
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Telephone | 201-991-8565
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Fax | 201-991-2408
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA02877100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 25MA02877100
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License Number State | NJ
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