Provider Demographics
NPI:1841564663
Name:ANELLO, GARY (RN, CDCES)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:ANELLO
Suffix:
Gender:M
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12493-0013
Mailing Address - Country:US
Mailing Address - Phone:845-706-3778
Mailing Address - Fax:845-384-6465
Practice Address - Street 1:PO BOX 13
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:NY
Practice Address - Zip Code:12493-0013
Practice Address - Country:US
Practice Address - Phone:845-706-3778
Practice Address - Fax:845-384-6465
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453485-1174H00000X
NY20810014163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No174H00000XOther Service ProvidersHealth Educator