Provider Demographics
NPI:1669432746
Name:BENTSIANOV, ANNA LEV (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LEV
Last Name:BENTSIANOV
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:40 W BRIGHTON AVE STE 103
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4901
Mailing Address - Country:US
Mailing Address - Phone:718-996-2260
Mailing Address - Fax:718-996-1123
Practice Address - Street 1:40 W BRIGHTON AVE STE 103
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4901
Practice Address - Country:US
Practice Address - Phone:718-996-2260
Practice Address - Fax:718-996-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2017-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY202022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01947759Medicaid
NY01947759Medicaid