Provider Demographics
NPI:1790544484
Name:RAGUSO, ANTHONY SALVATORE (FNP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:SALVATORE
Last Name:RAGUSO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CRANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2001
Mailing Address - Country:US
Mailing Address - Phone:347-861-4328
Mailing Address - Fax:
Practice Address - Street 1:162 CRANFORD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2001
Practice Address - Country:US
Practice Address - Phone:347-861-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily