Provider Demographics
NPI:1154455947
Name:FESTA, ANTHONY NMI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NMI
Last Name:FESTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:504 VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3534
Mailing Address - Country:US
Mailing Address - Phone:973-694-2690
Mailing Address - Fax:973-694-2762
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-694-2690
Practice Address - Fax:973-694-2762
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08445200207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08445200OtherMEDICAL LICENSE
NJ162301Medicare PIN