Provider Demographics
NPI:1558915736
Name:NGUYEN, ANTHONY
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLYNNE
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-2215
Mailing Address - Country:US
Mailing Address - Phone:856-246-2495
Mailing Address - Fax:
Practice Address - Street 1:PLAZA 38 SHOPPING CENTER, 1509 ROUTE 38
Practice Address - Street 2:SUITE 4
Practice Address - City:HAINESPORT, NJ 08036
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:609-702-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01865200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist