Provider Demographics
NPI:1720029457
Name:BOZZA, ANTHONY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:BOZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE
Mailing Address - Street 2:SUITE M 101
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:516-358-1091
Mailing Address - Fax:516-488-5025
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:SUITE M 101
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-358-1091
Practice Address - Fax:516-488-5025
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY114992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB-12369Medicare UPIN