Provider Demographics
NPI:1306664479
Name:KING, ANTHONY (RN)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3143
Mailing Address - Country:US
Mailing Address - Phone:917-480-7141
Mailing Address - Fax:
Practice Address - Street 1:130 LASALLE DR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3143
Practice Address - Country:US
Practice Address - Phone:917-480-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612626163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse