Provider Demographics
NPI:1770141277
Name:ASSERAF, NANCY ANASTASIA (DO)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANASTASIA
Last Name:ASSERAF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:ANASTASIA
Other - Last Name:BOBRYSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:165 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2521
Mailing Address - Country:US
Mailing Address - Phone:718-616-0999
Mailing Address - Fax:718-616-0933
Practice Address - Street 1:165 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2521
Practice Address - Country:US
Practice Address - Phone:718-616-0999
Practice Address - Fax:718-616-0933
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316804207Q00000X
NY316804-01207Q00000X
NJ25MB11440100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOT019057Medicaid