Provider Demographics
NPI:1518058916
Name:FLANDERS, ANTHONY C (PA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:FLANDERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1886 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7033
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:1886 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7033
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-247-8093
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY363AM0700X363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026852Medicare PIN