MEDICARE: ANNA POTASH M.D.

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	2084P0800X	Psychiatry Physician	194801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598760019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA POTASH M.D.

Provider Business Mailing Address
First Line	:	15 CEDAR LN N
Second Line	:
City	:	GLEN HEAD
State	:	NY
Zip	:	11545-1703
Country	:	US
Telephone Number	:	516-671-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 E 21ST ST
Second Line	:	APT A10
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5023
Country	:	US
Telephone Number	:	718-252-3702
Fax Number	:

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/02/2016

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