Provider Demographics
NPI:1164655783
Name:ASNA WELLNESS MEDICAL OB / GYN PC
Entity Type:Organization
Organization Name:ASNA WELLNESS MEDICAL OB / GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAIDA DZANIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CEMALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-731-2536
Mailing Address - Street 1:625 MAIN ST APT 337
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0033
Mailing Address - Country:US
Mailing Address - Phone:917-731-2536
Mailing Address - Fax:
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:917-731-2536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100019347Medicare PIN