Provider Demographics
NPI:1508964198
Name:MIRSKI, ANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:MIRSKI
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 1:35 BARNSLEY CRESCENT
Mailing Address - Street 2:
Mailing Address - City:MT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766
Mailing Address - Country:US
Mailing Address - Phone:516-680-4097
Mailing Address - Fax:
Practice Address - Street 1:3279 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:SUITE 5 MID ISLAND MEDICAL CENTER
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779
Practice Address - Country:US
Practice Address - Phone:631-737-4949
Practice Address - Fax:631-471-3599
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A62996Medicare UPIN
NYWER721Medicare ID - Type Unspecified