Provider Demographics
NPI:1497505739
Name:GAGARINA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GAGARINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635B 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1749
Mailing Address - Country:US
Mailing Address - Phone:347-325-2717
Mailing Address - Fax:
Practice Address - Street 1:635B 5TH ST
Practice Address - Street 2:
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072-1749
Practice Address - Country:US
Practice Address - Phone:347-325-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program