Individual
ANTHONY S MENCUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
790 AYRAULT RD, FAIRPORT, NY 14450
(585) 425-1018
(585) 425-8955
Mailing address
417 MACEDON CENTER RD, MACEDON, NY 14502
(315) 986-7544
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
0149671
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103116FT
PREFERRED CARE
NY
01
—
7344272
AETNA
NY
01
—
P010014967
BLUE CHOICE
NY
Enumeration date
11/21/2006
Last updated
02/24/2015
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