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General NPI Number Information
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NPI Number | 1740375898
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Entity Type | Individual
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Provider Name | ANTHONY PARKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 175 FRANKLIN AVENUE SUITE 103
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City | NUTLEY
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State | NJ
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Zip | 07110-1253
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Country | US
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Telephone | 973-661-1833
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Fax | 973-661-2270
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Provider Business Mailing Address
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Address Line | 175 FRANKLIN AVENUE SUITE 103
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City | NUTLEY
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State | NJ
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Zip | 07110-1253
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Country | US
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Telephone | 973-661-1833
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Fax | 973-661-2270
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 25MA07463100
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License Number State | NJ
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