Provider Demographics
NPI:1114019072
Name:STEPHEN, INFANTA ANUSHA (MD)
Entity Type:Individual
Prefix:
First Name:INFANTA
Middle Name:ANUSHA
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 WEST BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2560
Mailing Address - Country:US
Mailing Address - Phone:973-361-7606
Mailing Address - Fax:973-361-8942
Practice Address - Street 1:369 WEST BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:973-361-7606
Practice Address - Fax:973-361-8942
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA724532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
047839A3LMedicare ID - Type Unspecified
H37387Medicare UPIN