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General NPI Number Information
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NPI Number | 1184979155
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Entity Type | Individual
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Provider Name | ANAMARIE MEDINA MS
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 1311 MAMARONECK AVE STE 150
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City | WHITE PLAINS
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State | NY
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Zip | 10605-5222
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Country | US
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Telephone | 914-328-2868
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Fax | 914-328-2973
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Provider Business Mailing Address
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Address Line | 355 BRONX RIVER RD APT 5O
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City | YONKERS
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State | NY
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Zip | 10704-3413
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Country | US
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Telephone | 646-305-6005
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1786284
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License Number State | NY
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