Healthcare Provider Details

I. General information

NPI: 1285197871
Provider Name (Legal Business Name): JOHN ANTHONY BIANCHI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 SHEEPSHEAD BAY RD
BROOKLYN NY
11235-2792
US

IV. Provider business mailing address

115 EILEEN WAY
SYOSSET NY
11791-5323
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-3033
  • Fax:
Mailing address:
  • Phone: 516-795-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number306943
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number306943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: