Provider Demographics
NPI:1528152881
Name:LASAK, ANNA M (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:LASAK
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 1:4219 192ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2939
Mailing Address - Country:US
Mailing Address - Phone:718-405-8410
Mailing Address - Fax:718-405-8411
Practice Address - Street 1:MMC - REHABILITATION MEDICINE
Practice Address - Street 2:1500 BLONDELL AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-405-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221523208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation