Provider Demographics
NPI:1053877456
Name:GEORGE, ANIE JOSEPH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANIE
Middle Name:JOSEPH
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 EVAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2306
Mailing Address - Country:US
Mailing Address - Phone:845-634-1975
Mailing Address - Fax:
Practice Address - Street 1:9 EVAN DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2306
Practice Address - Country:US
Practice Address - Phone:845-634-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF343583OtherNURSE PRACTITIONER IN FAMILY HEALTH