Provider Demographics
NPI:1427233121
Name:DERIGGI, ANTHONY J
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:DERIGGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4929
Mailing Address - Country:US
Mailing Address - Phone:718-863-0777
Mailing Address - Fax:718-904-8044
Practice Address - Street 1:997 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3753
Practice Address - Country:US
Practice Address - Phone:718-863-0777
Practice Address - Fax:718-904-8044
Is Sole Proprietor?:No
Enumeration Date:2008-01-01
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011482-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor