Provider Demographics
NPI:1710137765
Name:TREVISANI LABELLA, ANNEMARIE (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:
Last Name:TREVISANI LABELLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANNEMARIE
Other - Middle Name:
Other - Last Name:TREVISANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:116 BUSINESS PARK DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6313
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:116 BUSINESS PARK DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6313
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012802-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012802-1OtherLICENSE
NY03126423Medicaid
NY03126423Medicaid