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General NPI Number Information
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NPI Number | 1952839300
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Entity Type | Individual
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Provider Name | ANTHONY R HAFEZ DO
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Gender | Male
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 212-241-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 50 N MEDICAL DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT017615
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 13340715-1204
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 310879-01
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License Number State | NY
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