Provider Demographics
NPI:1932146438
Name:BISWAS, ANJALI
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:BISWAS
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 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:REDBANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:908 OAK TREE AVE
Practice Address - Street 2:SUITE-N
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5100
Practice Address - Country:US
Practice Address - Phone:908-561-5551
Practice Address - Fax:908-561-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA399262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1225502Medicaid
NJ1450733CY4Medicare PIN
NJ1225502Medicaid