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General NPI Number Information
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NPI Number | 1154681922
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Entity Type | Organization
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Legal Business Name | ANAHITA MEDICAL GROUP
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 66 SOMME ST
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City | NEWARK
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State | NJ
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Zip | 07105-3612
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Country | US
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Telephone | 973-274-8044
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Fax | 973-578-2535
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Provider Business Mailing Address
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Address Line | 66 SOMME ST
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City | NEWARK
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State | NJ
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Zip | 07105-3612
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Country | US
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Telephone | 973-274-8044
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Fax | 973-578-2535
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LANETTE LABOY
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Credential |
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Telephone | 973-274-8044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NJ
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