Basic Information
| Provider Information | |||||||||
| NPI: | 1760784805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILIP | ||||||||
| FirstName: | ANIAMMA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 OLD ORANGEBURG RD | ||||||||
| Address2: | BUILDING 60 | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109621157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 OLD ORANGEBURG RD | ||||||||
| Address2: | BUILDING 60 | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109621157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2010 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 414153 | NY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.