Basic Information
| Provider Information | |||||||||
| NPI: | 1245350941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'KINSKY | ||||||||
| FirstName: | ANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 SHIP AVE | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087222526 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 IKEA DR | ||||||||
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| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092679339 | ||||||||
| FaxNumber: | 6092676655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 26NN10892500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 9003606 | 05 | NJ | MEDICAID |