Provider Demographics
NPI:1053325357
Name:VASTOLA, ANTHONY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PAUL
Last Name:VASTOLA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:300 CADMAN PLZ W
Practice Address - Street 2:SUITE 1301
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2701
Practice Address - Country:US
Practice Address - Phone:929-252-1566
Practice Address - Fax:718-208-4663
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY182035207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1511839Medicaid
NYBV4021022OtherDEA
NYA400101070Medicare PIN
NY15J69Medicare ID - Type Unspecified