Individual
ANTHONY MITAROTONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 NICOLLS ROAD, STONY BROOK, NY 11794-8460
(631) 444-5400
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(314) 444-5400
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
128030
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00670535
—
NY
01
—
CF3402
RR MEDICARE
NY
01
—
W11401
BC/BS
NY
01
—
W22111
MEDICARE GROUP SHR
NY
01
—
WEU091
MEDICARE GROUP HR
NY
Enumeration date
08/14/2006
Last updated
04/25/2022
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