Provider Demographics
NPI:1982832291
Name:VASILOV, ANATOLIY I (MD)
Entity Type:Individual
Prefix:
First Name:ANATOLIY
Middle Name:I
Last Name:VASILOV
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 1:905 HERRONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1901
Mailing Address - Country:US
Mailing Address - Phone:609-497-2640
Mailing Address - Fax:609-497-2641
Practice Address - Street 1:905 HERRONTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1901
Practice Address - Country:US
Practice Address - Phone:609-497-2640
Practice Address - Fax:609-497-2641
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA094253002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry