Healthcare Provider Details

I. General information

NPI: 1891655783
Provider Name (Legal Business Name): NINA DENISE ANASTASIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 LOCUST ST
FLORAL PARK NY
11001-3105
US

IV. Provider business mailing address

38 LOCUST ST
FLORAL PARK NY
11001-3105
US

V. Phone/Fax

Practice location:
  • Phone: 845-500-3330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: