Healthcare Provider Details

I. General information

NPI: 1083441729
Provider Name (Legal Business Name): ANUJ RAMESH BAMBHROLIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NJ-70
MANCHESTER TOWNSHIP NJ
08759
US

IV. Provider business mailing address

28 CRAWFORD ST
EATONTOWN NJ
07724-2911
US

V. Phone/Fax

Practice location:
  • Phone: 732-657-0099
  • Fax: 732-657-0033
Mailing address:
  • Phone: 732-857-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04334800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: