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General NPI Number Information
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NPI Number | 1023291887
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Entity Type | Individual
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Provider Name | ANANT KUMARIE NISCHAL PHD-IMD, P.A
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Gender | Female
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 1478 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3915
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Country | US
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Telephone | 718-442-3434
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Fax |
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Provider Business Mailing Address
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Address Line | 1478 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3915
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Country | US
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Telephone | 718-442-3434
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 004743
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00118500
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License Number State | NJ
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