Individual
ANTHONY PORRECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1650 GRAND CONCOURSE, BRONX, NY 10457
(000) 000-0000
Mailing address
1650 GRAND CONCOURSE, BRONX, NY 10457-7606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110005489
VA
363A00000X
Physician Assistant
Primary
PA9111252
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
NJ
Other
Enumeration date
10/31/2014
Last updated
05/25/2018
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