Healthcare Provider Details

I. General information

NPI: 1649492406
Provider Name (Legal Business Name): ANTHONY VERNILLO D.D.S., PH.D., MBE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E 24TH ST 838 SCHWARTZ
NEW YORK NY
10010-4020
US

IV. Provider business mailing address

3236 46TH ST
LONG ISLAND CITY NY
11103-1912
US

V. Phone/Fax

Practice location:
  • Phone: 121-299-8985
  • Fax:
Mailing address:
  • Phone: 171-877-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number033365-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: