Provider Demographics
NPI:1013963735
Name:ANELLO, PETER JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:ANELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WILLETS WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8781
Mailing Address - Country:US
Mailing Address - Phone:845-562-1054
Mailing Address - Fax:845-562-6148
Practice Address - Street 1:28 WILLETS WAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8781
Practice Address - Country:US
Practice Address - Phone:845-562-1054
Practice Address - Fax:845-562-6148
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163202251P0200X
NY016320-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT2211Medicare ID - Type Unspecified