Basic Information
Provider Information
NPI: 1205081445
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCARPULLA
FirstName: ANTHONY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 423 EAST 23RD STREET-14SOUTH
Address2: VA MEDICAL CENTER
City: NEW,YORK
State: NY
PostalCode: 10010
CountryCode: US
TelephoneNumber: 2126867500
FaxNumber:  
Practice Location
Address1: 423 EAST 23RD STREET-14SOUTH
Address2: VA MEDICAL CENTER
City: NEW,YORK
State: NY
PostalCode: 10010
CountryCode: US
TelephoneNumber: 2126867500
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/01/2008
LastUpdateDate: 12/01/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X  Y Other Service ProvidersSpecialist 

No ID Information.


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