Provider Demographics
NPI:1083996227
Name:VINCENT ANZALONE PHYSICIAN PC
Entity Type:Organization
Organization Name:VINCENT ANZALONE PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-798-0441
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-5651
Mailing Address - Fax:516-576-5820
Practice Address - Street 1:847 N BROADWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2373
Practice Address - Country:US
Practice Address - Phone:516-798-0441
Practice Address - Fax:516-798-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157952207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty