Provider Demographics
NPI:1609046630
Name:MCCABE, ANTHONY SR
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MCCABE
Suffix:SR
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 1:2604 S SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5012
Mailing Address - Country:US
Mailing Address - Phone:516-783-5454
Mailing Address - Fax:516-783-5454
Practice Address - Street 1:2604 S SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5012
Practice Address - Country:US
Practice Address - Phone:516-783-5454
Practice Address - Fax:516-783-5454
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYH0303060000171WH0202X
NY40287-H171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02934274Medicaid