Healthcare Provider Details

I. General information

NPI: 1619869864
Provider Name (Legal Business Name): MR. ANTHONY FRANK AMICONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 BROADVIEW AVE
YOUNGSTOWN OH
44509-1150
US

IV. Provider business mailing address

317 BROADVIEW AVE
YOUNGSTOWN OH
44509-1150
US

V. Phone/Fax

Practice location:
  • Phone: 330-951-6118
  • Fax:
Mailing address:
  • Phone: 330-951-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number201918601258
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: