Healthcare Provider Details

I. General information

NPI: 1134205073
Provider Name (Legal Business Name): ANTHONY M LOIZIDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

167 LAWRENCE AVE
EASTCHESTER NY
10709-5417
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2450
  • Fax:
Mailing address:
  • Phone: 718-741-2450
  • Fax: 718-515-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number232539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: