MEDICARE: DR. ANNE MAGNER DDS, MS

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	1223P0300X	Periodontics	35189	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35189	OTHER	NY	STATE ID NUMBER

General Provider Information

NPI Number	:	1619066958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE MAGNER DDS, MS

Provider Business Mailing Address
First Line	:	18 E 48TH ST
Second Line	:	1602
City	:	NEW YORK
State	:	NY
Zip	:	10017-1014
Country	:	US
Telephone Number	:	212-223-3800
Fax Number	:	212-223-3802

Provider Business Practice Location Address
First Line	:	18 E 48TH ST
Second Line	:	1602
City	:	NEW YORK
State	:	NY
Zip	:	10017-1014
Country	:	US
Telephone Number	:	212-223-3800
Fax Number	:	212-223-3802

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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