Healthcare Provider Details

I. General information

NPI: 1831192582
Provider Name (Legal Business Name): ANTHONY ORLANDO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date: 03/17/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

6741 WOODHAVEN BLVD
REGO PARK NY
11374-5217
US

IV. Provider business mailing address

6741 WOODHAVEN BLVD
REGO PARK NY
11374-5217
US

V. Phone/Fax

Practice location:
  • Phone: 718-459-9575
  • Fax: 718-459-9548
Mailing address:
  • Phone: 718-459-9575
  • Fax: 718-459-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number4266
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: