Healthcare Provider Details

I. General information

NPI: 1326286618
Provider Name (Legal Business Name): ANN M DNISTIRAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

633 3RD AVE BOX 3
NEW YORK NY
10017-6706
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License NumberDNISA1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberDNISA1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: