Healthcare Provider Details

I. General information

NPI: 1043373715
Provider Name (Legal Business Name): ANSHU GOYAL GARG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE 300
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

2190 CLOVE RD
STATEN ISLAND NY
10305-1543
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-8880
  • Fax: 908-994-8882
Mailing address:
  • Phone: 718-447-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number232971
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA07849300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: