Healthcare Provider Details

I. General information

NPI: 1295552487
Provider Name (Legal Business Name): ANNA URBANIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 ROUTE 17 STE 197
EAST RUTHERFORD NJ
07073-2224
US

IV. Provider business mailing address

280 ROUTE 17 STE 197
EAST RUTHERFORD NJ
07073-2224
US

V. Phone/Fax

Practice location:
  • Phone: 862-703-8972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6431
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: