Provider Demographics
NPI:1023156049
Name:DVORKINA, ANZHELA (MD)
Entity type:Individual
Prefix:DR
First Name:ANZHELA
Middle Name:
Last Name:DVORKINA
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 1:81 WILLOUGHBY ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5232
Mailing Address - Country:US
Mailing Address - Phone:718-522-3399
Mailing Address - Fax:718-522-1888
Practice Address - Street 1:81 WILLOUGHBY ST FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5232
Practice Address - Country:US
Practice Address - Phone:718-522-3399
Practice Address - Fax:718-522-1888
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749848Medicaid
NYG49415Medicare UPIN
NY01749848Medicaid