Provider Demographics
NPI:1710622063
Name:MNATSAKANYAN, ANI
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:MNATSAKANYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SHARROTTS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1948
Mailing Address - Country:US
Mailing Address - Phone:646-599-2407
Mailing Address - Fax:
Practice Address - Street 1:32 SHARROTTS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1948
Practice Address - Country:US
Practice Address - Phone:646-599-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
174400000XOtherBEHAVIORAL THERAPIST