Healthcare Provider Details

I. General information

NPI: 1265501381
Provider Name (Legal Business Name): ANNE NIESENBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MINEOLA BLVD
MINEOLA NY
11501-3917
US

IV. Provider business mailing address

135 MINEOLA BLVD
MINEOLA NY
11501-3917
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-4321
  • Fax: 516-741-8710
Mailing address:
  • Phone: 516-741-4321
  • Fax: 516-741-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number174021-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: