1285691113 NPI number — JOHN SALVATORE ANASTASI M.D.

Table of content: MRS. JESSY ROMANO MA (NPI 1912142738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285691113 NPI number — JOHN SALVATORE ANASTASI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANASTASI
Provider First Name:
JOHN
Provider Middle Name:
SALVATORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1285691113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1524
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30903-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-774-7263
Provider Business Mailing Address Fax Number:
706-774-7230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1348 WALTON WAY STE 5700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-722-8242
Provider Business Practice Location Address Fax Number:
706-722-8351
Provider Enumeration Date:
04/26/2006

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: 208G00000X , with the licence number:  ME123113 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 40182 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 77869 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03240 . This is a "HEALTH AMERICA/HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 251607393 . This is a "CIGNA/HEALTHSOURCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011750750001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1401306 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 72275 . This is a "MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PZ873 . This is a "FL HF MA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060008007 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 115862200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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