MEDICARE: ANAELLE HANNA ADLER

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	1223G0001X	General Practice Dentistry	062126	NY

General Provider Information

NPI Number	:	1841823150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAELLE HANNA ADLER

Provider Business Mailing Address
First Line	:	354 BEACH 9TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5536
Country	:	US
Telephone Number	:	516-477-8011
Fax Number	:

Provider Business Practice Location Address
First Line	:	5824 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4623
Country	:	US
Telephone Number	:	718-438-8400
Fax Number	:

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

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	12/12/2021

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