Provider Demographics
NPI:1447436522
Name:MARY ANN ADELFIO MD PC
Entity type:Organization
Organization Name:MARY ANN ADELFIO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-337-7324
Mailing Address - Street 1:25 OLD COLONY DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3812
Mailing Address - Country:US
Mailing Address - Phone:914-337-7711
Mailing Address - Fax:631-878-4280
Practice Address - Street 1:116 KRAFT AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4134
Practice Address - Country:US
Practice Address - Phone:914-337-7711
Practice Address - Fax:631-878-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151843207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY151843OtherLICENSE
NYG67623Medicare UPIN