Provider Demographics
NPI:1588745368
Name:ANASTASIO, DOMINICK J (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:J
Last Name:ANASTASIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:CHAPARAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2101 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3419
Mailing Address - Country:US
Mailing Address - Phone:718-721-7700
Mailing Address - Fax:718-721-4181
Practice Address - Street 1:2101 23RD AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3419
Practice Address - Country:US
Practice Address - Phone:718-721-7700
Practice Address - Fax:718-721-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4584572OtherAETNA
NY0401666OtherUNITED HEALTHCARE
NY27256OtherMAGNACARE
NY433537NOtherCIGNA
NY75K602OtherEMPIRE BLUE CROSS BS
NY01358218Medicaid
NYP391164OtherOXFORD
NY163264OtherELDERPLAN
NY2505421OtherGHI
NY75K602OtherEMPIRE BLUE CROSS BS
NY2505421OtherGHI