1568497436 NPI number — DR. GERALD A ANZALONE D.C.

Table of content: DR. GERALD A ANZALONE D.C. (NPI 1568497436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568497436 NPI number — DR. GERALD A ANZALONE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANZALONE
Provider First Name:
GERALD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568497436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 JUNIPER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROBINS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52328-9671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-350-6533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 JUNIPER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROBINS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52328-9671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-350-6533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X008552-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 006-0001009 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 510-1197 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: IA-006984 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1568497436 . This is a "NPI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 610536600 . This is a "FECA DCMWC FED WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 610536500 . This is a "FEDERAL WC DOL FECA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CO-8552-4B . This is a "NYS WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".