Provider Demographics
NPI:1003050782
Name:GHELECHKHANI, ANA M (PA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:GHELECHKHANI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:210 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4218
Mailing Address - Country:US
Mailing Address - Phone:516-279-4400
Mailing Address - Fax:516-279-4471
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-2608
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012181-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400002203Medicare PIN