MEDICARE: MR. ANTHONY PACIONE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	25MP00427900	NJ

General Provider Information

NPI Number	:	1861742579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY PACIONE PA-C

Provider Business Mailing Address
First Line	:	1 SEARS DR STE 306
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3510
Country	:	US
Telephone Number	:	201-830-2287
Fax Number	:	201-830-2286

Provider Business Practice Location Address
First Line	:	223 N VAN DIEN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-2736
Country	:	US
Telephone Number	:	201-447-8000
Fax Number	:	201-447-8019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	06/01/2022

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