Provider Demographics
NPI:1740375898
Name:PARKS, ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1253
Mailing Address - Country:US
Mailing Address - Phone:973-661-1833
Mailing Address - Fax:973-661-2270
Practice Address - Street 1:175 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1253
Practice Address - Country:US
Practice Address - Phone:973-661-1833
Practice Address - Fax:973-661-2270
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07463100207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41744Medicare UPIN