Provider Demographics
NPI:1578549838
Name:ANELISE ENGEL MD PC
Entity Type:Organization
Organization Name:ANELISE ENGEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:ANELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-223-0437
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-223-0437
Mailing Address - Fax:212-319-6179
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:SUITE 2-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-223-0437
Practice Address - Fax:212-319-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211830173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW831Medicare ID - Type Unspecified