Healthcare Provider Details

I. General information

NPI: 1659141273
Provider Name (Legal Business Name): OBINNA ANYANWU PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 NEWTON SPARTA RD STE 3
NEWTON NJ
07860-2764
US

IV. Provider business mailing address

100 ENTERPRISE DR STE 301
ROCKAWAY NJ
07866-2129
US

V. Phone/Fax

Practice location:
  • Phone: 833-494-6724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ14983500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: