Healthcare Provider Details

I. General information

NPI: 1588619753
Provider Name (Legal Business Name): ANTHONY LAURO CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 RAMAPO RD STE 2
GARNERVILLE NY
10923-1714
US

IV. Provider business mailing address

91 RAMAPO RD STE 2
GARNERVILLE NY
10923-1714
US

V. Phone/Fax

Practice location:
  • Phone: 845-786-2212
  • Fax: 845-786-2224
Mailing address:
  • Phone: 845-786-2212
  • Fax: 845-786-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: