Provider Demographics
NPI:1316973795
Name:ANASTASIO, NEIL J (PT)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:J
Last Name:ANASTASIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1942
Mailing Address - Country:US
Mailing Address - Phone:718-745-8282
Mailing Address - Fax:718-745-4394
Practice Address - Street 1:7410 11TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1942
Practice Address - Country:US
Practice Address - Phone:718-745-8282
Practice Address - Fax:718-745-4394
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ52231Medicare ID - Type UnspecifiedPHYSICAL THERAPY