Provider Demographics
NPI:1063483196
Name:BOUZIOTIS, ANASTASIOS (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ANASTASIOS
Middle Name:
Last Name:BOUZIOTIS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHELSEA WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3448
Mailing Address - Country:US
Mailing Address - Phone:908-229-2878
Mailing Address - Fax:
Practice Address - Street 1:719 US HIGHWAY 206 STE 104
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1529
Practice Address - Country:US
Practice Address - Phone:908-262-7404
Practice Address - Fax:908-262-7406
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01120600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087609TXQMedicare ID - Type Unspecified