Provider Demographics
NPI:1740356963
Name:CARELLA, ANTHONY VICTOR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:VICTOR
Last Name:CARELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2552
Mailing Address - Country:US
Mailing Address - Phone:914-249-7000
Mailing Address - Fax:914-249-7032
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:ORTHOPAEDIC SURGERY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00616266Medicaid
NY00616266Medicaid
NY382821Medicare ID - Type Unspecified