Healthcare Provider Details

I. General information

NPI: 1982978409
Provider Name (Legal Business Name): AN MEDICAL NY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MERMAID AVE
BROOKLYN NY
11224-2005
US

IV. Provider business mailing address

2563 E 6TH ST
BROOKLYN NY
11235-6201
US

V. Phone/Fax

Practice location:
  • Phone: 718-265-2222
  • Fax:
Mailing address:
  • Phone: 917-204-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number237360
License Number StateNY

VIII. Authorized Official

Name: DR. ALEX NATANZON
Title or Position: OWNER
Credential: MD
Phone: 917-204-7603