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General NPI Number Information
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NPI Number | 1841027117
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Entity Type | Individual
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Provider Name | ALEXANDRA K ANIBAN PA
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 462 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-9196
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Country | US
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Telephone | 212-562-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 1056 WILLOUGHBY AVE APT 3F
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City | BROOKLYN
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State | NY
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Zip | 11221-2711
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Country | US
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Telephone | 702-545-7213
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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 | 033703
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 033703
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License Number State | NY
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