Provider Demographics
NPI:1114951464
Name:MWANGI, GEORGE
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:MWANGI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:MWANGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12-45 RIVER RD # 317
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1812
Mailing Address - Country:US
Mailing Address - Phone:862-684-1789
Mailing Address - Fax:201-797-0410
Practice Address - Street 1:12-45 RIVER RD # 317
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1812
Practice Address - Country:US
Practice Address - Phone:862-684-1789
Practice Address - Fax:201-797-0410
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00076600225X00000X
NY009765-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist