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General NPI Number Information
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NPI Number | 1689910861
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Entity Type | Organization
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Legal Business Name | ANTHONY K BOLTON PHD NEUROPSYCHOLOGY PC
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 170 ROUTE 25A
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City | ROCKY POINT
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State | NY
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Zip | 11778-8750
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Country | US
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Telephone | 631-331-4377
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Fax | 631-331-4459
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Provider Business Mailing Address
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Address Line | 170 ROUTE 25A
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City | ROCKY POINT
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State | NY
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Zip | 11778-8750
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Country | US
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Telephone | 631-331-4377
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Fax | 631-331-4459
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANTHONY BOLTON
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Credential | PHD
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Telephone | 631-331-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 011367-1
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License Number State | NY
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