Provider Demographics
NPI:1821596099
Name:PESTINE, ANNA (CNM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PESTINE
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4005
Mailing Address - Country:US
Mailing Address - Phone:855-681-8700
Mailing Address - Fax:718-681-6840
Practice Address - Street 1:2412 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4005
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:718-681-6840
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002096367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA496268Medicaid