Provider Demographics
NPI:1154585925
Name:ANNUNZIATO, ANGELO JOSEPH (ATC)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:JOSEPH
Last Name:ANNUNZIATO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 93RD ST
Mailing Address - Street 2:#9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3707
Mailing Address - Country:US
Mailing Address - Phone:212-860-3066
Mailing Address - Fax:
Practice Address - Street 1:240 E 93RD ST
Practice Address - Street 2:#9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3707
Practice Address - Country:US
Practice Address - Phone:212-860-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001602-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer