Provider Demographics
NPI:1750328688
Name:YATSKAR, ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:YATSKAR
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 1:86 BELL POINT DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6328
Mailing Address - Country:US
Mailing Address - Phone:917-822-2176
Mailing Address - Fax:877-739-5368
Practice Address - Street 1:1711 SHEEPSHEAD BAY RD
Practice Address - Street 2:2 FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3651
Practice Address - Country:US
Practice Address - Phone:718-615-0014
Practice Address - Fax:877-739-5368
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02172154Medicaid
NY22S293OtherMEDICARE PTAN
NY22S293OtherMEDICARE PTAN