MEDICARE: DR. ANTHONY PERSO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X006235	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CO-6235-8	OTHER	NY	WORKMAN COMP PROVIDER #

General Provider Information

NPI Number	:	1932223567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY PERSO D.C.

Provider Business Mailing Address
First Line	:	530 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-797-7504
Fax Number	:	516-797-7497

Provider Business Practice Location Address
First Line	:	530 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-797-7504
Fax Number	:	516-797-7497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/09/2007

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