Provider Demographics
NPI:1689910861
Name:ANTHONY K BOLTON PHD NEUROPSYCHOLOGY PC
Entity Type:Organization
Organization Name:ANTHONY K BOLTON PHD NEUROPSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-331-4377
Mailing Address - Street 1:170 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8750
Mailing Address - Country:US
Mailing Address - Phone:631-331-4377
Mailing Address - Fax:631-331-4459
Practice Address - Street 1:170 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8750
Practice Address - Country:US
Practice Address - Phone:631-331-4377
Practice Address - Fax:631-331-4459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011367-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty