Healthcare Provider Details

I. General information

NPI: 1114261245
Provider Name (Legal Business Name): ANH DANG NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 DITMARS BLVD
ASTORIA NY
11105-1319
US

IV. Provider business mailing address

4502 DITMARS BLVD
ASTORIA NY
11105-1319
US

V. Phone/Fax

Practice location:
  • Phone: 718-777-6314
  • Fax: 718-728-3207
Mailing address:
  • Phone: 718-777-6314
  • Fax: 718-728-3207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402520
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number662035-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: