Healthcare Provider Details

I. General information

NPI: 1558232108
Provider Name (Legal Business Name): ANNADALE NP IN FAMILY HEALTH P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3974 AMBOY RD STE 302
STATEN ISLAND NY
10308-2414
US

IV. Provider business mailing address

3974 AMBOY RD STE 302
STATEN ISLAND NY
10308-2414
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-1071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IRENA HOVHANNISYAN
Title or Position: FNP
Credential: FNP
Phone: 646-406-9286