Provider Demographics
NPI:1790978955
Name:ROZENTUL, ANNA V (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:V
Last Name:ROZENTUL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SMIRNOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 SEA BREEZE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3701
Mailing Address - Country:US
Mailing Address - Phone:718-338-0300
Mailing Address - Fax:718-513-0434
Practice Address - Street 1:2175 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3205
Practice Address - Country:US
Practice Address - Phone:646-828-6401
Practice Address - Fax:646-828-6403
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10058000207Q00000X
NY250561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty