1598082463 NPI number — SHIRLEY A ANAIN MD PC

Table of content: (NPI 1598082463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598082463 NPI number — SHIRLEY A ANAIN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIRLEY A ANAIN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598082463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4949 HARLEM RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-838-1333
Provider Business Mailing Address Fax Number:
716-835-5595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4949 HARLEM RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-838-1333
Provider Business Practice Location Address Fax Number:
716-835-5595
Provider Enumeration Date:
04/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MELBER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MEDICAL PRACTICE MANAGER
Authorized Official Telephone Number:
716-838-1333

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  187404 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1308585 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 187404 . This is a "STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000511535003 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426000908 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01382636 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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