Provider Demographics
NPI:1083714307
Name:ZONGARO, ANTHONY J (PHD, DABPS)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:ZONGARO
Suffix:
Gender:M
Credentials:PHD, DABPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 VERREE RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3611
Mailing Address - Country:US
Mailing Address - Phone:215-327-1335
Mailing Address - Fax:
Practice Address - Street 1:10125 VERREE RD
Practice Address - Street 2:SUITE #102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3611
Practice Address - Country:US
Practice Address - Phone:215-332-1914
Practice Address - Fax:215-332-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 004983-L103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34933Medicare UPIN
PA0531398000OtherMAGELLAN ID
PA696301OtherBC/BS ID
PA34933Medicare UPIN