Healthcare Provider Details

I. General information

NPI: 1659780211
Provider Name (Legal Business Name): HUMA ANSARI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROUTE 1 SUITE 416
PRINCETON NJ
08540-5903
US

IV. Provider business mailing address

3535 ROUTE 1 SUITE 416
PRINCETON NJ
08540-5903
US

V. Phone/Fax

Practice location:
  • Phone: 609-520-1008
  • Fax: 609-520-9279
Mailing address:
  • Phone: 609-520-1008
  • Fax: 609-520-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00635900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: