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General NPI Number Information
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NPI Number | 1952753964
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Entity Type | Individual
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Provider Name | ANTHONY D CONGIUSTA MD, DDS
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Gender | Male
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 159 SACHEM ST
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City | NORWICH
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State | CT
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Zip | 06360-4144
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Country | US
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Telephone | 860-885-0444
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Fax | 860-885-0816
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Provider Business Mailing Address
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Address Line | 630 PIERCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19148-1720
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Country | US
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Telephone | 917-359-6088
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 75128
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 13740
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License Number State | CT
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