Provider Demographics
NPI:1750468492
Name:COLANTONIO, ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:COLANTONIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 MAPLE AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4267
Mailing Address - Country:US
Mailing Address - Phone:516-746-3310
Mailing Address - Fax:516-248-3044
Practice Address - Street 1:434 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5636
Practice Address - Country:US
Practice Address - Phone:718-346-3355
Practice Address - Fax:718-346-9381
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY163260208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01513024Medicaid