Healthcare Provider Details

I. General information

NPI: 1477895100
Provider Name (Legal Business Name): FEBY A GEWARGY I 07/16/83
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FEBY ANEES GEWARGY I 07/16/83

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 FERRY ST 745 BERGEN AVE
NEWARK NJ
07105-1831
US

IV. Provider business mailing address

73 FERRY ST NEWARK
HUDSON NJ
07002-0700
US

V. Phone/Fax

Practice location:
  • Phone: 347-681-5054
  • Fax: 347-681-5853
Mailing address:
  • Phone: 347-681-5054
  • Fax: 347-681-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03548300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: