Provider Demographics
NPI:1518045996
Name:COMMENTUCCI, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:COMMENTUCCI
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 1:944 N BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1304
Mailing Address - Country:US
Mailing Address - Phone:914-476-1520
Mailing Address - Fax:914-968-5612
Practice Address - Street 1:944 N BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1304
Practice Address - Country:US
Practice Address - Phone:914-476-1520
Practice Address - Fax:914-968-5612
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01229565Medicaid
NY73F29Medicare ID - Type Unspecified
NYE69931Medicare UPIN