Healthcare Provider Details

I. General information

NPI: 1386106938
Provider Name (Legal Business Name): ANITA KRISH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 DITMARS BLVD
ASTORIA NY
11105-2300
US

IV. Provider business mailing address

11 CARROL PL
GREENLAWN NY
11740-2729
US

V. Phone/Fax

Practice location:
  • Phone: 718-274-4040
  • Fax: 718-726-6414
Mailing address:
  • Phone: 631-793-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007227-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN007227-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: