Provider Demographics
NPI:1194250274
Name:ABAGYAN-STANCZYK, ANAIDA (DPM)
Entity type:Individual
Prefix:
First Name:ANAIDA
Middle Name:
Last Name:ABAGYAN-STANCZYK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANAIDA
Other - Middle Name:
Other - Last Name:ABAGYAN-STANCZYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:24 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8011
Mailing Address - Country:US
Mailing Address - Phone:631-666-8100
Mailing Address - Fax:631-665-2227
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:4TH FL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-2712
Practice Address - Fax:718-661-7129
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY007157213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program