Provider Demographics
NPI:1578741732
Name:OSMUNDSON, ANITA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MARIE
Last Name:OSMUNDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:28 THROCKMORTON LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2558
Mailing Address - Country:US
Mailing Address - Phone:732-679-6300
Mailing Address - Fax:732-679-9566
Practice Address - Street 1:250 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2635
Practice Address - Country:US
Practice Address - Phone:732-780-7870
Practice Address - Fax:732-679-9566
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010168207N00000X
OK4608207ND0101X, 207NS0135X, 207N00000X
NJ25MB08611500207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100749090BMedicaid
OKOK401136Medicare PIN
OK100749090BMedicaid