Healthcare Provider Details

I. General information

NPI: 1700132859
Provider Name (Legal Business Name): BISMA ANWAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 05/11/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-36 24TH ST
ASTORIA NY
11106
US

IV. Provider business mailing address

4203 UNION DEPOSIT RD # 1118
HARRISBURG PA
17111-2802
US

V. Phone/Fax

Practice location:
  • Phone: 347-625-7462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: