Provider Demographics
NPI:1881780039
Name:GUOBADIA, ANTHONY (PA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GUOBADIA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:2444 WALTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6407
Practice Address - Country:US
Practice Address - Phone:718-220-8293
Practice Address - Fax:718-220-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001059OtherPROFESSIONAL LICENSE