Individual
ANTHONY CONSOLAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4417 VESTAL PARKWAY EAST, SUITE 101, VESTAL, NY 13850-3556
(607) 729-2144
(607) 729-2145
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 729-8156
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
230312
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02492933
—
NY
Enumeration date
09/29/2005
Last updated
03/17/2016
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