1790916773 NPI number — MRS. ANNA KARASIK BELENKY P.T.

Table of content: MRS. ANNA KARASIK BELENKY P.T. (NPI 1790916773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790916773 NPI number — MRS. ANNA KARASIK BELENKY P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELENKY
Provider First Name:
ANNA
Provider Middle Name:
KARASIK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARASIK
Provider Other First Name:
ANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790916773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 W 66TH ST
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-920-8088
Provider Business Mailing Address Fax Number:
952-920-5162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 W 66TH ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-920-8088
Provider Business Practice Location Address Fax Number:
952-920-5162
Provider Enumeration Date:
08/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8369 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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