MEDICARE: ANZHELIKA BRISKIN PA

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	363A00000X	Physician Assistant	010386-1	NY

General Provider Information

NPI Number	:	1629259296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANZHELIKA BRISKIN PA

Provider Business Mailing Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:	STE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5606
Country	:	US
Telephone Number	:	718-332-3200
Fax Number	:	718-332-3319

Provider Business Practice Location Address
First Line	:	1009 BRIGHTON BEACH AVE
Second Line	:	STE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5606
Country	:	US
Telephone Number	:	718-332-3200
Fax Number	:	718-332-3319

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

Provider Enumeration Date	:	11/23/2007
Last Update Date	:	11/23/2007

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Directions to “ ANZHELIKA BRISKIN PA” Practice Location

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