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General NPI Number Information
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NPI Number | 1598256042
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Entity Type | Individual
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Provider Name | ANNE ELIZABETH WATTERS DPT
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Gender | Female
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 1592 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1529
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Country | US
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Telephone | 347-857-6368
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Fax |
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Provider Business Mailing Address
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Address Line | 17 FLORENCE ST
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City | STATEN ISLAND
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State | NY
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Zip | 10308-3235
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Country | US
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Telephone |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036709
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License Number State | NY
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