1760489538 NPI number — DR. LAWRENCE J ANASTASI DO

Table of content: DR. LAWRENCE J ANASTASI DO (NPI 1760489538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760489538 NPI number — DR. LAWRENCE J ANASTASI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANASTASI
Provider First Name:
LAWRENCE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1760489538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9501 VENTNOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARGATE CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08402-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-823-6161
Provider Business Mailing Address Fax Number:
609-823-3413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 VENTNOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08402-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-823-6161
Provider Business Practice Location Address Fax Number:
609-823-3413
Provider Enumeration Date:
07/07/2005

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: 207Q00000X , with the licence number:  MB33294 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13532 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J1796 . This is a "HORIZON POS/HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3248909 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4058286 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4897404 . This is a "UNYSIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3098 . This is a "AETNA CAP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: FIRST HEALTH . This is a "823644" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: ATP030 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1226281003 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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