Healthcare Provider Details

I. General information

NPI: 1346982493
Provider Name (Legal Business Name): ANTHONIA OLUFUNKE GEORGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

5801 POSTAL RD UNIT 81310
CLEVELAND OH
44181-2112
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-4882
  • Fax:
Mailing address:
  • Phone: 301-340-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH0108004
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: