Provider Demographics
NPI:1922006659
Name:DR. LAWRENCE J ANASTASI, PA
Entity type:Organization
Organization Name:DR. LAWRENCE J ANASTASI, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANASTASI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-823-6161
Mailing Address - Street 1:9501 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2218
Mailing Address - Country:US
Mailing Address - Phone:609-823-6161
Mailing Address - Fax:609-823-3413
Practice Address - Street 1:9501 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2218
Practice Address - Country:US
Practice Address - Phone:609-823-6161
Practice Address - Fax:609-823-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ646151005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ13532OtherAETNA US HEALTHCARE
NJ3248909Medicaid
NJ021236602OtherCIGNA
NJ0506248001OtherAMERIHEALTH
NJ3098OtherAETNA
NJ3098OtherAETNA
NJ3098OtherAETNA