Provider Demographics
NPI:1912052895
Name:RINIS, ANASTASIA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:RINIS
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 1:722 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2435
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2099
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-739-0352
Practice Address - Fax:607-739-6909
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225344207Q00000X
NY252280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03276717Medicaid
NY03276717Medicaid