Provider Demographics
NPI:1992898639
Name:PORIZKOVA, ANNA MARIE (CNM)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:PORIZKOVA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GLEN RD
Mailing Address - Street 2:F3
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-3121
Mailing Address - Country:US
Mailing Address - Phone:914-330-5788
Mailing Address - Fax:
Practice Address - Street 1:3611 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4705
Practice Address - Country:US
Practice Address - Phone:718-482-7772
Practice Address - Fax:718-482-4698
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000354367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00695941Medicaid
NY00695941Medicaid
NY00246075Medicaid
NY00330128Medicare ID - Type Unspecified