Provider Demographics
NPI:1013961085
Name:ANIL NERURKAR
Entity type:Organization
Organization Name:ANIL NERURKAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NERURKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-322-6220
Mailing Address - Street 1:4 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4324
Mailing Address - Country:US
Mailing Address - Phone:215-322-6220
Mailing Address - Fax:215-322-7443
Practice Address - Street 1:4 ROSE AVE
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053-4324
Practice Address - Country:US
Practice Address - Phone:215-322-6220
Practice Address - Fax:215-322-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037711-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA465928Medicare ID - Type Unspecified
PAC28530Medicare UPIN