Basic Information
Provider Information | |||||||||
NPI: | 1144281056 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | POZZUTO | ||||||||
FirstName: | ANTHONY | ||||||||
MiddleName: | JOSEPH | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CCC SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2128 ELMWOOD AVE | ||||||||
Address2: |   | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142071910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168744500 | ||||||||
FaxNumber: | 7168748145 | ||||||||
Practice Location | |||||||||
Address1: | 2128 ELMWOOD AVE | ||||||||
Address2: |   | ||||||||
City: | BUFFALO | ||||||||
State: | NY | ||||||||
PostalCode: | 142071910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7168744500 | ||||||||
FaxNumber: | 7168748145 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 015308 | NY | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
ID Information
ID | Type | State | Issuer | Description | 000640230001 | 01 |   | COMMUNITY CARE MANAGED CA | OTHER | 000640230001 | 01 |   | COMMUNITY BLUE HMO STANDA | OTHER | 000640230001 | 01 |   | CB ADVANTAGE HMO 201-203 | OTHER | 000640230001 | 01 |   | TRADITIONAL SECURE BLUE P | OTHER | 00027078602 | 01 |   | UNIVERA COMMERCIAL | OTHER | 000640230001 | 01 |   | HEALTHY NY HNY 201 | OTHER | 01465154 | 05 | NY |   | MEDICAID | 00027078602 | 01 |   | ASO | OTHER | 000640230001 | 01 |   | CB LABOR HEALTH HMO 204 | OTHER | 050421000037 | 01 |   | FIDELIS CHILD HEALTH PLUS | OTHER | 050421000037 | 01 |   | FIDELIS FAMILY HEALTH PLU | OTHER | 00027078602 | 01 |   | SENIOR CHOICE | OTHER | 000640230001 | 01 |   | BCBS WNY | OTHER | 000640230001 | 01 |   | CHILD HEALTH PLUS FAMILY | OTHER | 050421000037 | 01 |   | FIDELIS | OTHER |