1821096884 NPI number — DR. ANTHONY JOSEPH SANZONE DPM

Table of content: DR. ANTHONY JOSEPH SANZONE DPM (NPI 1821096884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821096884 NPI number — DR. ANTHONY JOSEPH SANZONE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANZONE
Provider First Name:
ANTHONY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821096884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
ENDICOTT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13760-5036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-785-3388
Provider Business Mailing Address Fax Number:
607-785-4072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
ENDICOTT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13760-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-785-3388
Provider Business Practice Location Address Fax Number:
607-785-4072
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N004135-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161356692 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10034355 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01007047 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4556107 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 540007 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0049122 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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