Individual provider Active NPI

Anthony T. Vetrano, M.D.

  • Pediatrics Physician
  • Lackawanna, NY
National Provider Identifier
1982636650
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
171758 Issued in NY
Practice address
790 Ridge Rd FL 1
Lackawanna, NY 14218-1629
Phone
(716) 893-7337
Fax
(716) 893-7699
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 171758 NY Primary

Addresses

Primary practice location

790 Ridge Rd FL 1
Lackawanna, NY 14218-1629

Mailing address

790 Ridge Rd FL 1
Lackawanna, NY 14218-1629
Phone (716) 893-7337

Other identifiers 6

IdentifierTypeStateIssuer
000510859007OtherNYBLUE CROSS
050728000000OtherNYFIDELIS
01191877MedicaidNY
1207848OtherNYINDEPENDENT HEALTH
00010199001OtherNYUNIVERA
119288DLOtherNYPREFERRED CARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
171758NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Century Airport Pediatrics P.C. Pediatrics Past Accepting new patients
Anthony T. Vetrano M.D. Pediatrics Past Accepting new patients
Baker Victory Healthcare Center Pediatrics PastSince Apr 27, 2025 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: anthonyvetrano@cap.allscriptsdirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1982636650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD FL 1",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-893-7337",
            "fax_number": "716-893-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD FL 1",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-893-7337",
            "fax_number": "716-893-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VETRANO",
        "first_name": "ANTHONY",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "171758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000510859007",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "050728000000",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01191877",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "1207848",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00010199001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "119288DL",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackawanna, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.