# MARIDANIELLE D. ANNICCHIARICO, REGISTERED PHYSICIAN ASSISTANT-CERTIFIE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801040126
- **Authorized official:** MARIDANIELLE D. ANNICCHIARICO RPA-C (DIRECTOR)
- **Authorized official phone:** (845) 566-4595

## Contact information

- **Practice address:** 15 BLACK ANGUS CT, NEWBURGH, NY 12550-1567
- **Practice address phone:** (845) 566-4595
- **Mailing address:** PO BOX 10082, NEWBURGH, NY 12552-0082
- **Mailing address phone:** (845) 566-4595

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 005535-1 | NY | Yes |

## Other

- **Enumeration date:** 11/13/2008
- **Last updated:** 11/13/2008