Provider Demographics
NPI:1205220910
Name:GEORGE, ANNAMMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNAMMA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FRANKLIN TPKE STE 6A
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1836
Mailing Address - Country:US
Mailing Address - Phone:201-447-3603
Mailing Address - Fax:201-447-5184
Practice Address - Street 1:140 FRANKLIN TPKE STE 6A
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1836
Practice Address - Country:US
Practice Address - Phone:201-447-3603
Practice Address - Fax:201-447-5184
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00534600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner