Provider Demographics
NPI:1760723316
Name:DR. ANTHONY CORRADO, LLC
Entity Type:Organization
Organization Name:DR. ANTHONY CORRADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-344-5906
Mailing Address - Street 1:1919 GREENTREE RD
Mailing Address - Street 2:STE C
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1115
Mailing Address - Country:US
Mailing Address - Phone:856-344-5906
Mailing Address - Fax:
Practice Address - Street 1:1919 GREENTREE RD
Practice Address - Street 2:STE C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1115
Practice Address - Country:US
Practice Address - Phone:856-344-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07820800207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty