Provider Demographics
NPI:1598760019
Name:POTASH, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:POTASH
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 1:15 CEDAR LN N
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1703
Mailing Address - Country:US
Mailing Address - Phone:516-671-9089
Mailing Address - Fax:
Practice Address - Street 1:1695 E 21ST ST
Practice Address - Street 2:APT A10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5023
Practice Address - Country:US
Practice Address - Phone:718-252-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1948012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01523317Medicaid
NY01523317Medicaid
NY03M561Medicare ID - Type UnspecifiedPROVDIER NUMBER