Healthcare Provider Details

I. General information

NPI: 1790837268
Provider Name (Legal Business Name): GARY ANFANG P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GREENWOOD LAKE TPKE SUITE 101
RINGWOOD NJ
07456-1500
US

IV. Provider business mailing address

20 GREENWOOD LAKE TPKE SUITE 101
RINGWOOD NJ
07456-1500
US

V. Phone/Fax

Practice location:
  • Phone: 973-616-0442
  • Fax: 973-616-0442
Mailing address:
  • Phone: 973-616-0442
  • Fax: 973-616-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00291700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA00291700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: