Basic Information
| Provider Information | |||||||||
| NPI: | 1639674013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AURICCHIO | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112303338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477212367 | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 W 168TH ST PH 5-133 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053226 | ||||||||
| FaxNumber: | 2123053204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.