Provider Demographics
NPI:1689617961
Name:MASCIOLI, ANTHONY H (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:H
Last Name:MASCIOLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1030
Mailing Address - Country:US
Mailing Address - Phone:315-331-7056
Mailing Address - Fax:
Practice Address - Street 1:918 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1030
Practice Address - Country:US
Practice Address - Phone:315-462-9667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP023081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00552649Medicaid
NY00552649Medicaid
NY16492BMedicare PIN
18043BMedicare PIN