Provider Demographics
NPI:1265481394
Name:SMAGA, ANIZIYA D (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANIZIYA
Middle Name:D
Last Name:SMAGA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-0049
Mailing Address - Country:US
Mailing Address - Phone:718-270-1691
Mailing Address - Fax:718-270-1985
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:BOX 49
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-1691
Practice Address - Fax:718-270-1985
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36OtherPHYSICIAN ASSISTANT