Provider Demographics
NPI:1952721342
Name:PRESVOT, ANNIE (TEACHER)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:PRESVOT
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894B UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3949
Mailing Address - Country:US
Mailing Address - Phone:646-714-7134
Mailing Address - Fax:718-513-0583
Practice Address - Street 1:894B UNION AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3949
Practice Address - Country:US
Practice Address - Phone:646-714-7134
Practice Address - Fax:718-513-0583
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2129243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist