Healthcare Provider Details

I. General information

NPI: 1003050782
Provider Name (Legal Business Name): ANA M GHELECHKHANI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

210 OLD COUNTRY RD
MINEOLA NY
11501-4218
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-2608
  • Fax: 516-437-4167
Mailing address:
  • Phone: 516-279-4400
  • Fax: 516-279-4471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012181-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: