Provider Demographics
NPI:1801854575
Name:KULISHEVSKY, ANNA (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KULISHEVSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1850
Mailing Address - Country:US
Mailing Address - Phone:212-434-2650
Mailing Address - Fax:212-434-4512
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1850
Practice Address - Country:US
Practice Address - Phone:212-434-2650
Practice Address - Fax:212-434-4512
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02720616Medicaid
NY02720616Medicaid
NY5038L23051Medicare PIN
P91046Medicare UPIN