Provider Demographics
NPI:1093014367
Name:ANNA LERNER ANGELES MD PC
Entity type:Organization
Organization Name:ANNA LERNER ANGELES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-670-6701
Mailing Address - Street 1:2171 JERICHO TPKE STE 300
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2912
Mailing Address - Country:US
Mailing Address - Phone:631-670-6701
Mailing Address - Fax:631-670-6704
Practice Address - Street 1:2171 JERICHO TPKE STE 300
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2912
Practice Address - Country:US
Practice Address - Phone:631-670-6701
Practice Address - Fax:631-670-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty