Healthcare Provider Details

I. General information

NPI: 1487582060
Provider Name (Legal Business Name): ANNA BANGIYEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 NORTHERN BLVD
JACKSON HEIGHTS NY
11372-1223
US

IV. Provider business mailing address

63164 ALDERTON ST
REGO PARK NY
11374-3945
US

V. Phone/Fax

Practice location:
  • Phone: 347-836-5824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357166
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number357166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: