Provider Demographics
NPI:1972526150
Name:ANZALONE, MICHAEL JAMES (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:ANZALONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075
Mailing Address - Country:US
Mailing Address - Phone:716-646-4000
Mailing Address - Fax:716-646-0694
Practice Address - Street 1:5449 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075
Practice Address - Country:US
Practice Address - Phone:716-646-4000
Practice Address - Fax:716-646-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY240301Medicare PIN
NYU42701Medicare UPIN