Provider Demographics
NPI:1174664270
Name:BAKALARZ, ANETTA TERESA (MS)
Entity Type:Individual
Prefix:MISS
First Name:ANETTA
Middle Name:TERESA
Last Name:BAKALARZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ANETTA
Other - Middle Name:TERESA
Other - Last Name:BAKALARZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:227-08 HILLSIDE AVENUE APT. #1
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2626
Mailing Address - Country:US
Mailing Address - Phone:718-465-4934
Mailing Address - Fax:718-465-4934
Practice Address - Street 1:227-08 HILLSIDE AVENUE APT. #1
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2626
Practice Address - Country:US
Practice Address - Phone:718-465-4934
Practice Address - Fax:718-465-4934
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program