Healthcare Provider Details

I. General information

NPI: 1285441170
Provider Name (Legal Business Name): ANNE BIZUB PHD, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 04/14/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WASHINGTON BLVD
JERSEY CITY NJ
07310-1606
US

IV. Provider business mailing address

801 SHELBY ST STE 212
INDIANAPOLIS IN
46203-1163
US

V. Phone/Fax

Practice location:
  • Phone: 888-721-3003
  • Fax:
Mailing address:
  • Phone: 888-721-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71016511A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26NJ15192100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ15192100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NJ15192100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: