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General NPI Number Information
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NPI Number | 1609275130
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Entity Type | Organization
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Legal Business Name | RAN D ANBAR, INC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 7005 OLD QUARRY RD
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-9733
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Country | US
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Telephone | 315-446-3721
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Fax |
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Provider Business Mailing Address
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Address Line | 7005 OLD QUARRY RD
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-9733
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Country | US
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Telephone | 315-446-3721
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAN DANI ANBAR
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Credential | M.D.
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Telephone | 315-446-3721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 132184
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License Number State | CA
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