Provider Demographics
NPI:1740237940
Name:NATELLI, ANTHONY ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALBERT
Last Name:NATELLI
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 1:2035 HAMBURG TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6251
Mailing Address - Country:US
Mailing Address - Phone:973-835-2844
Mailing Address - Fax:973-835-6955
Practice Address - Street 1:2035 HAMBURG TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6251
Practice Address - Country:US
Practice Address - Phone:973-835-2844
Practice Address - Fax:973-835-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03860700207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1697102Medicaid
NJ1697102Medicaid
NJNA453704Medicare ID - Type Unspecified