Provider Demographics
NPI:1083286769
Name:GEORGE, ANSA
Entity Type:Individual
Prefix:
First Name:ANSA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANSA
Other - Middle Name:
Other - Last Name:KURIAKOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1810
Mailing Address - Country:US
Mailing Address - Phone:607-763-6075
Mailing Address - Fax:607-763-5234
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1810
Practice Address - Country:US
Practice Address - Phone:607-763-6075
Practice Address - Fax:607-763-5234
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program