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General NPI Number Information
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NPI Number | 1568730067
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Entity Type | Organization
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Legal Business Name | ANYA, LLC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 275 CENTRAL PARK W SUITE 1F
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City | NEW YORK
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State | NY
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Zip | 10024-3015
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Country | US
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Telephone | 646-852-7594
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Fax | 201-944-8481
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Provider Business Mailing Address
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Address Line | 21 HAWTHORNE TER
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City | LEONIA
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State | NJ
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Zip | 07605-1118
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Country | US
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Telephone | 646-852-7594
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Fax | 201-944-8481
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Authorized Official
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Title or Position | OWNER
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Name | DR. VERA KISHINEVSKY
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Credential | PH. D.
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Telephone | 646-852-7594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 015193-1
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License Number State | NY
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