Healthcare Provider Details

I. General information

NPI: 1356961221
Provider Name (Legal Business Name): MRS. ANISH NAYAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25156 RIDING CENTER DR
CHANTILLY VA
20152-6049
US

IV. Provider business mailing address

25156 RIDING CENTER DR
CHANTILLY VA
20152-6049
US

V. Phone/Fax

Practice location:
  • Phone: 732-277-8100
  • Fax:
Mailing address:
  • Phone: 732-277-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-1868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: