Provider Demographics
NPI:1124346689
Name:ANZALONE, ANTHONY J (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:ANZALONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-5601
Mailing Address - Country:US
Mailing Address - Phone:631-209-5343
Mailing Address - Fax:631-648-7655
Practice Address - Street 1:1919 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-5601
Practice Address - Country:US
Practice Address - Phone:631-209-5343
Practice Address - Fax:631-648-7655
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018271103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent