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General NPI Number Information
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NPI Number | 1811085392
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Entity Type | Individual
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Provider Name | VINCENT P ANZALONE MD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 02/19/2021
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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 | 516-797-8044
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Provider Business Mailing Address
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Address Line | 79 ASTER STRRET
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2373
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Country | US
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Telephone | 519-798-0093
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Fax |
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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 | 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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