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General NPI Number Information
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NPI Number | 1801040126
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Entity Type | Organization
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Legal Business Name | MARIDANIELLE D. ANNICCHIARICO, REGISTERED PHYSICIAN ASSISTANT-CERTIFIE
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 15 BLACK ANGUS CT
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City | NEWBURGH
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State | NY
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Zip | 12550-1567
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Country | US
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Telephone | 845-566-4595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10082
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City | NEWBURGH
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State | NY
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Zip | 12552-0082
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Country | US
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Telephone | 845-566-4595
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIDANIELLE D. ANNICCHIARICO
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Credential | RPA-C
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Telephone | 845-566-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 005535-1
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License Number State | NY
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