Healthcare Provider Details

I. General information

NPI: 1467769208
Provider Name (Legal Business Name): ANGELO POZZUTO MSED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 SPENCER DR
BRONX NY
10465-1263
US

IV. Provider business mailing address

3245 SPENCER DR
BRONX NY
10465-1263
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-0274
  • Fax:
Mailing address:
  • Phone: 718-918-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: