Provider Demographics
NPI:1336354778
Name:AVANZATO, ANTHONY ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ROBERT
Last Name:AVANZATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 BRUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5625
Mailing Address - Country:US
Mailing Address - Phone:718-822-4262
Mailing Address - Fax:718-824-6368
Practice Address - Street 1:3713 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2019
Practice Address - Country:US
Practice Address - Phone:718-822-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG45381Medicare UPIN
NY30U591Medicare PIN