Provider Demographics
NPI:1366685133
Name:ANNA SUPONYA, MD, PC
Entity type:Organization
Organization Name:ANNA SUPONYA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPONYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-8373
Mailing Address - Street 1:9920 4TH AVE
Mailing Address - Street 2:SUITE206
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8333
Mailing Address - Country:US
Mailing Address - Phone:718-238-8373
Mailing Address - Fax:718-238-8375
Practice Address - Street 1:9920 4TH AVE
Practice Address - Street 2:SUITE206
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8333
Practice Address - Country:US
Practice Address - Phone:718-238-8373
Practice Address - Fax:718-238-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02575588Medicaid
NYIO2536Medicare UPIN