Provider Demographics
NPI:1720587041
Name:ANJUM, NIKHAT
Entity Type:Individual
Prefix:
First Name:NIKHAT
Middle Name:
Last Name:ANJUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13702 NORTHERN BLVD APT 8B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4176
Mailing Address - Country:US
Mailing Address - Phone:631-877-0535
Mailing Address - Fax:
Practice Address - Street 1:76-49 HEWLETT STREET NEW HYDE PARK NY 11040
Practice Address - Street 2:
Practice Address - City:QUEENS NY
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:212-388-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty