Provider Demographics
NPI:1992817456
Name:ADAMO, ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ADAMO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:STE 222
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3012
Mailing Address - Country:US
Mailing Address - Phone:631-422-8822
Mailing Address - Fax:631-422-0798
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:STE 222
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3012
Practice Address - Country:US
Practice Address - Phone:631-422-8822
Practice Address - Fax:631-422-0798
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1758482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01770130Medicaid
NY01770130Medicaid
NY373N01Medicare PIN