Healthcare Provider Details

I. General information

NPI: 1326425398
Provider Name (Legal Business Name): DR. ANNA CORNISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. ANNW SVERKUNOVA

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

11 CRANFORD ST
STATEN ISLAND NY
10308-3025
US

V. Phone/Fax

Practice location:
  • Phone: 646-515-6412
  • Fax:
Mailing address:
  • Phone: 646-515-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number295183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: