Provider Demographics
NPI:1265670277
Name:ANNA ARSENOUS PHYSICIAN PLLC
Entity Type:Organization
Organization Name:ANNA ARSENOUS PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-821-1000
Mailing Address - Street 1:7919 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7441
Mailing Address - Country:US
Mailing Address - Phone:718-821-1000
Mailing Address - Fax:718-821-4685
Practice Address - Street 1:7919 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7441
Practice Address - Country:US
Practice Address - Phone:718-821-1000
Practice Address - Fax:718-821-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02471Medicare PIN