Healthcare Provider Details

I. General information

NPI: 1033452487
Provider Name (Legal Business Name): ANWAR MGHARI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DAVIS DR
RIVER EDGE NJ
07661-1702
US

IV. Provider business mailing address

106 DAVIS DR
RIVER EDGE NJ
07661-1702
US

V. Phone/Fax

Practice location:
  • Phone: 201-655-9297
  • Fax:
Mailing address:
  • Phone: 201-655-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number725688
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: