Provider Demographics
NPI:1336219948
Name:INGUAGGIATO, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:INGUAGGIATO
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 1:4302 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5022
Mailing Address - Country:US
Mailing Address - Phone:201-863-5673
Mailing Address - Fax:201-863-1372
Practice Address - Street 1:4302 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5022
Practice Address - Country:US
Practice Address - Phone:201-863-5673
Practice Address - Fax:201-863-1372
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ56358207RC0000X
NY182576207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7436106Medicaid
NY01472577Medicaid
NYF63144Medicare UPIN
NJF63144Medicare UPIN
NJ7436106Medicaid
NY01472577Medicaid