Healthcare Provider Details

I. General information

NPI: 1386409407
Provider Name (Legal Business Name): IKENNA ANYANWU PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 US HIGHWAY 206 STE 3
FLANDERS NJ
07836-9287
US

IV. Provider business mailing address

20 COMMERCE DR STE 135
CRANFORD NJ
07016-3614
US

V. Phone/Fax

Practice location:
  • Phone: 908-916-3582
  • Fax:
Mailing address:
  • Phone: 908-916-3582
  • Fax: 908-605-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15006000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: