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General NPI Number Information
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NPI Number | 1871594432
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Entity Type | Individual
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Provider Name | VENIS F FANOUS MD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 10/21/2023
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Provider Practice Location Address
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Address Line | 59 BRUNSWICK WOODS DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5601
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Country | US
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Telephone | 732-238-3883
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Fax | 732-238-4826
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Provider Business Mailing Address
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Address Line | 59 BRUNSWICK WOODS DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5601
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Country | US
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Telephone | 732-238-3883
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Fax | 732-238-4826
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MA 41914
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License Number State | NJ
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