Provider Demographics
NPI:1407851637
Name:LONE, ANSER N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSER
Middle Name:N
Last Name:LONE
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 1:1 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-632-3666
Mailing Address - Fax:
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-4174
Practice Address - Fax:631-224-8560
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00165373OtherRAILROAD MEDICARE #
NY02157197Medicaid
NY75S041OtherBLUE CROSS BLUE SHIELD
NY75S041OtherBLUE CROSS BLUE SHIELD
NY75S041Medicare ID - Type UnspecifiedMEDICARE PROVIDER #