Healthcare Provider Details

I. General information

NPI: 1508776873
Provider Name (Legal Business Name): ANISA SIMONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 UNION TPKE STE 303
FRESH MEADOWS NY
11366-1960
US

IV. Provider business mailing address

1063 WARD AVE
BRONX NY
10472-5955
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-7250
  • Fax: 718-264-7922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: