MEDICARE: DR. ANTHONY L PUCILLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	139259	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	060023510	OTHER	NY	RAIIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619970530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY L PUCILLO MD

Provider Business Mailing Address
First Line	:	PO BOX 28064
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-8064
Country	:	US
Telephone Number	:	914-593-7880
Fax Number	:	914-593-7881

Provider Business Practice Location Address
First Line	:	19 BRADHURST AVE
Second Line	:	STE 700
City	:	HAWTHORNE
State	:	NY
Zip	:	10532-2140
Country	:	US
Telephone Number	:	914-593-7800
Fax Number	:	914-593-7857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/05/2015

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