Healthcare Provider Details

I. General information

NPI: 1114446549
Provider Name (Legal Business Name): EMILY NICOLE ANTHONISEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

MOUNT SINAI WEST 1000 10TH AVE
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-8312
  • Fax:
Mailing address:
  • Phone: 212-523-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342025-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: