Provider Demographics
NPI:1740221696
Name:ANNALISA TOLENTINO
Entity type:Organization
Organization Name:ANNALISA TOLENTINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:718-670-1572
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:RM W238
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-1572
Mailing Address - Fax:718-670-1864
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:RM W238
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-1572
Practice Address - Fax:718-670-1864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK HOSPITAL MEDICAL CENTER OF QUEENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty