Provider Demographics
NPI:1508991811
Name:DIPASTINA, ANTHONY R (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:DIPASTINA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55845
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-6845
Mailing Address - Country:US
Mailing Address - Phone:609-394-5111
Mailing Address - Fax:609-394-8242
Practice Address - Street 1:2141 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4407
Practice Address - Country:US
Practice Address - Phone:609-394-5111
Practice Address - Fax:609-394-8242
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8040109Medicaid
NJT44608Medicare UPIN
NJ047221NGPMedicare ID - Type UnspecifiedMEDICARE