Healthcare Provider Details

I. General information

NPI: 1447206727
Provider Name (Legal Business Name): ANELLA N BAYSHTOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 AVENUE X
BROOKLYN NY
11235-2910
US

IV. Provider business mailing address

2101 AVENUE X
BROOKLYN NY
11235-2910
US

V. Phone/Fax

Practice location:
  • Phone: 718-512-2160
  • Fax:
Mailing address:
  • Phone: 718-512-2160
  • Fax: 718-891-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number159403-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: