Provider Demographics
NPI:1306884408
Name:PAWLIK, ANNA T (MD)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:T
Last Name:PAWLIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DRIGGS AVE
Mailing Address - Street 2:MEDICAL PLAZA
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:718-383-4555
Mailing Address - Fax:718-383-3290
Practice Address - Street 1:225 DRIGGS AVE
Practice Address - Street 2:MEDICAL PLAZA
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:718-383-4555
Practice Address - Fax:718-383-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY199988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016105458Medicaid
NY01605458046Medicaid
NYGO9909Medicare UPIN
NY522472Medicare ID - Type Unspecified