Provider Demographics
NPI:1740787647
Name:BRUTICO, ANTHONY GABRIEL (DPM)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GABRIEL
Last Name:BRUTICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAPLE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431
Mailing Address - Country:US
Mailing Address - Phone:570-253-8177
Mailing Address - Fax:484-763-3777
Practice Address - Street 1:HONESDALE PODIATRY
Practice Address - Street 2:600 MAPLE AVE, SUITE 4
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-8177
Practice Address - Fax:484-763-3777
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0069O9213ES0103X
390200000X
PASC006909213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program