Provider Demographics
NPI:1548259021
Name:DESANO, ANTHONY S (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:S
Last Name:DESANO
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 1:8416 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1920
Mailing Address - Country:US
Mailing Address - Phone:718-296-6900
Mailing Address - Fax:718-296-0737
Practice Address - Street 1:8416 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1920
Practice Address - Country:US
Practice Address - Phone:718-296-6900
Practice Address - Fax:718-296-0737
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5802282OtherGHI
NYP2100896OtherOXFORD
NYP2100896OtherOXFORD
NY5802282OtherGHI