Healthcare Provider Details

I. General information

NPI: 1154585925
Provider Name (Legal Business Name): ANGELO JOSEPH ANNUNZIATO ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 93RD ST #9G
NEW YORK NY
10128-3707
US

IV. Provider business mailing address

240 E 93RD ST #9G
NEW YORK NY
10128-3707
US

V. Phone/Fax

Practice location:
  • Phone: 212-860-3066
  • Fax:
Mailing address:
  • Phone: 212-860-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001602-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: