Healthcare Provider Details

I. General information

NPI: 1003433954
Provider Name (Legal Business Name): ANTHONY N TANGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 CARMEL RD
MILLVILLE NJ
08332-9754
US

IV. Provider business mailing address

1640 WHISPERING WOODS DR
WILLIAMSTOWN NJ
08094-3366
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-6810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP023446
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01141100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: