Provider Demographics
NPI:1790837268
Name:ANFANG, GARY (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:ANFANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREENWOOD LAKE TPKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1500
Mailing Address - Country:US
Mailing Address - Phone:973-616-0442
Mailing Address - Fax:973-616-0442
Practice Address - Street 1:20 GREENWOOD LAKE TPKE
Practice Address - Street 2:SUITE 101
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1500
Practice Address - Country:US
Practice Address - Phone:973-616-0442
Practice Address - Fax:973-616-0442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00291700225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAN478699Medicare ID - Type Unspecified