Provider Demographics
NPI:1952379323
Name:PRIBIS, ANNEKE (MD)
Entity type:Individual
Prefix:
First Name:ANNEKE
Middle Name:
Last Name:PRIBIS
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 1:5344 SACANDAGA RD
Mailing Address - Street 2:P.O. BOX 190
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-2424
Mailing Address - Country:US
Mailing Address - Phone:518-882-6955
Mailing Address - Fax:518-882-5575
Practice Address - Street 1:5344 SACANDAGA RD
Practice Address - Street 2:
Practice Address - City:GALWAY
Practice Address - State:NY
Practice Address - Zip Code:12074-2424
Practice Address - Country:US
Practice Address - Phone:518-882-6955
Practice Address - Fax:518-882-5575
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9664Medicare ID - Type Unspecified
NYH31382Medicare UPIN