Provider Demographics
NPI:1518178094
Name:CONTARINO, ANA GRISELDA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:GRISELDA
Last Name:CONTARINO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MARISA CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2054
Mailing Address - Country:US
Mailing Address - Phone:718-605-1955
Mailing Address - Fax:
Practice Address - Street 1:148 MARISA CIR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2054
Practice Address - Country:US
Practice Address - Phone:718-605-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00107100363A00000X
NY009376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03315542Medicaid
NJ115004WJ8Medicare PIN
NY03315542Medicaid