Provider Demographics
NPI:1982904991
Name:DWOSKIN, ANNE VASILAS (ANP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:VASILAS
Last Name:DWOSKIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MAIN RD
Mailing Address - Street 2:STE F
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1957
Mailing Address - Country:US
Mailing Address - Phone:631-288-7120
Mailing Address - Fax:
Practice Address - Street 1:189 MAIN RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1957
Practice Address - Country:US
Practice Address - Phone:631-288-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300629363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health