Provider Demographics
NPI:1407927478
Name:ANMUTH, CRAIG J (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:J
Last Name:ANMUTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W. JIMMIE LEEDS ROAD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0723
Mailing Address - Country:US
Mailing Address - Phone:609-748-5380
Mailing Address - Fax:609-652-8749
Practice Address - Street 1:61 W. JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0723
Practice Address - Country:US
Practice Address - Phone:609-748-5380
Practice Address - Fax:609-652-8749
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB62172208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6614400Medicaid
NJ792205Medicare PIN
NJF05157Medicare UPIN