Provider Demographics
NPI:1447206727
Name:BAYSHTOK, ANELLA N (MD)
Entity Type:Individual
Prefix:
First Name:ANELLA
Middle Name:N
Last Name:BAYSHTOK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2910
Mailing Address - Country:US
Mailing Address - Phone:718-512-2160
Mailing Address - Fax:718-891-8911
Practice Address - Street 1:2101 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2910
Practice Address - Country:US
Practice Address - Phone:718-512-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159403-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01103566Medicaid
NYP00392928OtherRR MEDICARE
NY01103566Medicaid
NYP00392928OtherRR MEDICARE