Provider Demographics
NPI:1720679269
Name:SCLAFANI, ANTHONY PAUL
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PAUL
Last Name:SCLAFANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHESHIRE PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3606
Mailing Address - Country:US
Mailing Address - Phone:917-968-4842
Mailing Address - Fax:
Practice Address - Street 1:433 W UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1220
Practice Address - Country:US
Practice Address - Phone:732-356-3113
Practice Address - Fax:732-356-6691
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02604800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty