Provider Demographics
NPI:1659500387
Name:ANNA M MIRSKI PRIMARY MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:ANNA M MIRSKI PRIMARY MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIRSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-648-9660
Mailing Address - Street 1:1690 WASHINGTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1425
Mailing Address - Country:US
Mailing Address - Phone:631-648-9660
Mailing Address - Fax:631-648-9661
Practice Address - Street 1:1690 WASHINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1425
Practice Address - Country:US
Practice Address - Phone:631-648-9660
Practice Address - Fax:631-648-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty