Provider Demographics
NPI:1013044460
Name:ORTOLANO, ANTHONY J (AT,C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:ORTOLANO
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 DUNHAM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12062-2509
Mailing Address - Country:US
Mailing Address - Phone:518-766-5658
Mailing Address - Fax:
Practice Address - Street 1:110 8TH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3522
Practice Address - Country:US
Practice Address - Phone:518-276-6730
Practice Address - Fax:518-276-2059
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer