Healthcare Provider Details

I. General information

NPI: 1740787647
Provider Name (Legal Business Name): ANTHONY GABRIEL BRUTICO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 01/15/2025
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HONESDALE PODIATRY 600 MAPLE AVE, SUITE 4
HONESDALE PA
18431
US

IV. Provider business mailing address

600 MAPLE AVE SUITE 4
HONESDALE PA
18431
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8177
  • Fax: 484-763-3777
Mailing address:
  • Phone: 570-253-8177
  • Fax: 484-763-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC0069O9
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006909
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: