Provider Demographics
NPI:1366483174
Name:ANASTASIADES, ATHOS C (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHOS
Middle Name:C
Last Name:ANASTASIADES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6318
Mailing Address - Country:US
Mailing Address - Phone:201-991-8565
Mailing Address - Fax:201-991-2408
Practice Address - Street 1:62 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6318
Practice Address - Country:US
Practice Address - Phone:201-991-8565
Practice Address - Fax:201-991-2408
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02877100207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0933503Medicaid
NJ547283AYBOtherMEDICARE ID - TYPE UNSPECIFIED
NJ0933503Medicaid
NJC56971Medicare UPIN