Provider Demographics
NPI:1043572100
Name:JAIN, ANA SILVIA (TEACHER)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:SILVIA
Last Name:JAIN
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 GOETHALS RD N FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7205
Mailing Address - Country:US
Mailing Address - Phone:347-881-6295
Mailing Address - Fax:
Practice Address - Street 1:641 GOETHALS RD N FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7205
Practice Address - Country:US
Practice Address - Phone:347-881-6295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
NY483935101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator