MEDICARE: PANTELEYMON ANASTASAKIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	15626	CT
2	1041C0700X	Clinical Social Worker	44SC06560600	NJ
3	1041C0700X	Clinical Social Worker	114988	TX
4	1041C0700X	Clinical Social Worker	093691	NY
5	1041C0700X	Clinical Social Worker	CSW009977	GA
6	1041C0700X	Clinical Social Worker	LC24455	ME

General Provider Information

NPI Number	:	1467977314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANTELEYMON ANASTASAKIS

Provider Business Mailing Address
First Line	:	2248 BROADWAY # 2047
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5805
Country	:	US
Telephone Number	:	929-900-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2248 BROADWAY # 2047
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5805
Country	:	US
Telephone Number	:	929-900-3001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	03/05/2026

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Directions to “ PANTELEYMON ANASTASAKIS ” Practice Location

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