MS. ANNA G. CUSTODIO


Address: 480 Main St Apt 3g, New York, NY 10044-0406
Phone: 8455212887

MS. ANNA G. CUSTODIO (NPI# 1275149106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1275149106
Entity Type Individual
Full Name MS. ANNA G. CUSTODIO
Credential AGPCNP-BC
Practice Address 480 Main St Apt 3g
New York
NY 10044-0406
Practice Telephone 8455212887
Mailing Telephone 8455212887
Enumeration Date 2020-09-16
Last Update Date 2020-09-16
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 163W00000X Registered Nurse 604515 NY Nursing Service Providers
Y 363LP2300X Nurse Practitioner
Specialization: Primary Care
F309861-01 NY Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
535 East 73rd St, New York, NY 10044 6466083824 6462277246

Office Location

Street Address 480 MAIN ST APT 3G
City NEW YORK
State NY
Zip Code 10044-0406

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Taxonomy Information

Taxonomy Code 363LP2300X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Primary Care

Taxonomy Definition

Definition to come...

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Competitor

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City NEW YORK
Zip Code 10044

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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