Provider Demographics
NPI:1598787640
Name:BOTTI, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BOTTI
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 1:349 E NORTHFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4802
Mailing Address - Country:US
Mailing Address - Phone:973-597-0900
Mailing Address - Fax:973-597-0910
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4802
Practice Address - Country:US
Practice Address - Phone:973-597-0900
Practice Address - Fax:973-597-0910
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA045092207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA60869Medicare UPIN
NJ564547NT1Medicare PIN