Basic Information
Provider Information
NPI: 1528247848
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEHARRY
FirstName: ANNETTE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 55 WATER ST FL 2
Address2:  
City: NEW YORK
State: NY
PostalCode: 100410004
CountryCode: US
TelephoneNumber: 6466802888
FaxNumber: 5165425556
Practice Location
Address1: 125-06 101ST STREET
Address2:  
City: S RICHMOND HILLS
State: NY
PostalCode: 11419
CountryCode: US
TelephoneNumber: 7188492900
FaxNumber: 7185995468
Other Information
ProviderEnumerationDate: 11/02/2007
LastUpdateDate: 09/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X239745NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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