Provider Demographics
NPI:1659313609
Name:SCARDELLA, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SCARDELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:11 CENTRE DR
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-395-2460
Practice Address - Fax:609-409-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA035545207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0460206Medicaid
NJ290003883OtherRAILROAD MEDICARE PTAN
NJC58016Medicare UPIN
NJ0460206Medicaid
NJ181652Medicare PIN