Healthcare Provider Details

I. General information

NPI: 1508090929
Provider Name (Legal Business Name): ANKUR TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-1710
  • Fax:
Mailing address:
  • Phone: 908-788-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD452217
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number40192
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA10604700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: