Provider Demographics
NPI:1225170954
Name:MOMI, ANUDEEP (DO)
Entity Type:Individual
Prefix:DR
First Name:ANUDEEP
Middle Name:
Last Name:MOMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ROUTE 73
Mailing Address - Street 2:SUITE #1
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9542
Mailing Address - Country:US
Mailing Address - Phone:856-809-0909
Mailing Address - Fax:856-809-1919
Practice Address - Street 1:200 ROUTE 73
Practice Address - Street 2:SUITE #1
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9542
Practice Address - Country:US
Practice Address - Phone:856-809-0909
Practice Address - Fax:856-809-1919
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB 66137207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine