Basic Information
| Provider Information | |||||||||
| NPI: | 1598016933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONGCO | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | LLAMOSO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 BAY PARKWAY | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182382100 | ||||||||
| FaxNumber: | 7185345606 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 BAY PARKWAY | ||||||||
| Address2: | SUITE 901 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182382100 | ||||||||
| FaxNumber: | 7185345606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2012 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/13/2013 | ||||||||
| NPIReactivationDate: | 09/04/2013 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | F340843-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | F306043-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.