Healthcare Provider Details

I. General information

NPI: 1417819145
Provider Name (Legal Business Name): ANU K CHEMPOLA MSN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

4632 BRONX BLVD
BRONX NY
10470-1449
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF312627-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: