Provider Demographics
NPI:1003043522
Name:ANOSIKE, DOMINIC
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:ANOSIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SHAKESPEARE AVE
Mailing Address - Street 2:3C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3908
Mailing Address - Country:US
Mailing Address - Phone:718-537-4484
Mailing Address - Fax:
Practice Address - Street 1:1600 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1103
Practice Address - Country:US
Practice Address - Phone:718-918-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289654164W00000X
NY643501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse