Provider Demographics
NPI:1811946197
Name:MOTTA, ANNE (DO)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MOTTA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17900 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11425-0001
Mailing Address - Country:US
Mailing Address - Phone:718-526-1000
Mailing Address - Fax:718-298-8436
Practice Address - Street 1:17900 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11425-0001
Practice Address - Country:US
Practice Address - Phone:718-526-1000
Practice Address - Fax:718-298-8436
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01655738Medicaid
10G202Medicare ID - Type Unspecified
NY01655738Medicaid