MEDICARE: DR. ANNA SHAROVETSKAYA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	286762	NY

General Provider Information

NPI Number	:	1275896292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA SHAROVETSKAYA D.O.

Provider Business Mailing Address
First Line	:	10 REGENT ST
Second Line	:	#213
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-7321
Country	:	US
Telephone Number	:	917-572-2271
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 REGENT ST
Second Line	:	#213
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-7321
Country	:	US
Telephone Number	:	917-572-2271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	12/26/2016

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