Provider Demographics
NPI:1700186541
Name:STOFFO, ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:STOFFO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 BURKE AVENUE
Mailing Address - Street 2:A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:646-417-0981
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVENUE VILLA BUILDING 1ST FLOOR
Practice Address - Street 2:DEPT. OF SURGERY, RICHMOND UNIVERSITY MEDICAL CENTER
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY004174-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant