Healthcare Provider Details

I. General information

NPI: 1386997534
Provider Name (Legal Business Name): ANYI ALFRED EJOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6852 RIVERDALE RD APT,101
LANHAM MD
20706-1053
US

IV. Provider business mailing address

6852 RIVERDALE RD APT.101
LANHAM MD
20706-1053
US

V. Phone/Fax

Practice location:
  • Phone: 240-354-3066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: