Provider Demographics
NPI:1366451148
Name:GIRARDI, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GIRARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MEDICAL PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2102
Mailing Address - Country:US
Mailing Address - Phone:516-676-4596
Mailing Address - Fax:516-674-0502
Practice Address - Street 1:8 MEDICAL PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2102
Practice Address - Country:US
Practice Address - Phone:516-676-4596
Practice Address - Fax:516-674-0502
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147396207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00835598Medicaid
NYB11373Medicare UPIN
NY24D761Medicare PIN