Provider Demographics
NPI:1538411079
Name:BLUNDETTO, ANTHONY (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BLUNDETTO
Suffix:
Gender:M
Credentials:MPAS, PA-C
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:132 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-8470
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 PLAZA CT
Practice Address - Street 2:SUITE C
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8263
Practice Address - Country:US
Practice Address - Phone:570-421-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical