Healthcare Provider Details

I. General information

NPI: 1730705161
Provider Name (Legal Business Name): ANNA TOKAREVA MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CRANFORD CT
STATEN ISLAND NY
10306-2083
US

IV. Provider business mailing address

3 ANDREWS RD APT 12
TROY NY
12180-8438
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-5809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: