Provider Demographics
NPI:1154428779
Name:MANDRACCHIA, ANTHONY STEPHEN (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:STEPHEN
Last Name:MANDRACCHIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3125
Mailing Address - Country:US
Mailing Address - Phone:718-605-2225
Mailing Address - Fax:718-966-5630
Practice Address - Street 1:6659 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3125
Practice Address - Country:US
Practice Address - Phone:718-605-2225
Practice Address - Fax:718-966-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02044728Medicaid
NY2032523OtherUNITED HEALTHCARE
NYX1024OtherBCBS
NYX1024OtherBCBS