Healthcare Provider Details

I. General information

NPI: 1093602807
Provider Name (Legal Business Name): ANNA VIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK AVE RM 1600
NEW YORK NY
10017-5538
US

IV. Provider business mailing address

48 DANIEL RD S
NORTH MASSAPEQUA NY
11758-2210
US

V. Phone/Fax

Practice location:
  • Phone: 347-229-6356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: