Provider Demographics
NPI:1932109717
Name:MASCIARELLI, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MASCIARELLI
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0593
Mailing Address - Country:US
Mailing Address - Phone:609-463-2755
Mailing Address - Fax:609-463-2757
Practice Address - Street 1:217 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2165
Practice Address - Country:US
Practice Address - Phone:609-536-8010
Practice Address - Fax:609-536-8053
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05261500207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5440904Medicaid
F28940Medicare UPIN
NJ5440904Medicaid
NJ716984WXTMedicare PIN