Provider Demographics
NPI:1134497118
Name:ANTHONY ADDESSO DC PC
Entity Type:Organization
Organization Name:ANTHONY ADDESSO DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDESSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-784-4931
Mailing Address - Street 1:1740 44TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1050
Mailing Address - Country:US
Mailing Address - Phone:347-784-4931
Mailing Address - Fax:212-531-6136
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:ST 1200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:800-930-7808
Practice Address - Fax:212-531-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004438-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty