1073568747 NPI number — ANTHONY A. AZZARELLO PA

Table of content: ANTHONY A. AZZARELLO PA (NPI 1073568747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073568747 NPI number — ANTHONY A. AZZARELLO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AZZARELLO
Provider First Name:
ANTHONY
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1073568747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX BOX 864074
Provider Second Line Business Mailing Address:
HALIFAX HEALTHCARE SYSTEMS, INC.
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32886-4074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-226-4590
Provider Business Mailing Address Fax Number:
386-226-3371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 NO. CLYDE MORRIS BLVD.
Provider Second Line Business Practice Location Address:
HALIFAX MEDICAL CENTER - CHEST PAIN CENTER
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-425-1800
Provider Business Practice Location Address Fax Number:
386-425-1804
Provider Enumeration Date:
05/23/2006

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: 363A00000X , with the licence number:  PA9103151 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 292228200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022984500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com