Provider Demographics
NPI:1386933372
Name:BOSE-KOLANU, ANJALI ELLEN (MD)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:ELLEN
Last Name:BOSE-KOLANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:ELLEN
Other - Last Name:KOLANU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:FL 2
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 673
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8673
Practice Address - Country:US
Practice Address - Phone:585-275-1200
Practice Address - Fax:585-244-2529
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2821612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program