Healthcare Provider Details

I. General information

NPI: 1497290266
Provider Name (Legal Business Name): ANNA PORAY STANICZENKO M.D. M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA PORAY GODDU

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1283 YORK AVENUE 12TH FLOOR
NEW YORK NY
10065
US

IV. Provider business mailing address

525 EAST 68TH STREET BOX 122
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-9715
  • Fax:
Mailing address:
  • Phone: 646-962-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number321504
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number321504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: