Healthcare Provider Details

I. General information

NPI: 1952535288
Provider Name (Legal Business Name): MOSES E ANYAEGBU MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 WATERTON DR
BEAR DE
19701-4918
US

IV. Provider business mailing address

42 WATERTON DR
BEAR DE
19701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 267-304-0981
  • Fax:
Mailing address:
  • Phone: 267-304-0981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: