Provider Demographics
NPI:1104809078
Name:SOMOGYI, ANTHONY A
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:SOMOGYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 FRANCIS LEWIS BLVD STE L3B
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3028
Mailing Address - Country:US
Mailing Address - Phone:718-224-5687
Mailing Address - Fax:718-224-5746
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD STE L3B
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3028
Practice Address - Country:US
Practice Address - Phone:718-224-5687
Practice Address - Fax:718-224-5746
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF09442Medicare UPIN
NY08171GMedicare UPIN