MEDICARE: DEBORAH AANONSEN 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	190729	NY

General Provider Information

NPI Number	:	1952395717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH AANONSEN D.O.

Provider Business Mailing Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 314
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-815-3033
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 RALPH PL
Second Line	:	SUITE 314
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4419
Country	:	US
Telephone Number	:	718-815-3033
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/05/2008

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