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General NPI Number Information
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NPI Number | 1477436079
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Entity Type | Individual
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Provider Name | ANTHONY RAYMOND MAINELLA RN
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Gender | Male
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 60 ACADEMY RD
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City | ALBANY
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State | NY
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Zip | 12208-3103
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Country | US
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Telephone | 518-912-4808
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Fax | 518-514-1383
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Provider Business Mailing Address
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Address Line | 105 HYDE BLVD
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City | BALLSTON SPA
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State | NY
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Zip | 12020-1600
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Country | US
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Telephone | 518-461-9531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 743550
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License Number State | NY
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