Healthcare Provider Details

I. General information

NPI: 1013370964
Provider Name (Legal Business Name): ANASTASIA KRIVKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1150
US

IV. Provider business mailing address

10420 QUEENS BLVD APT 2R
FOREST HILLS NY
11375-3614
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3539
  • Fax:
Mailing address:
  • Phone: 516-395-2562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number305923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: