Provider Demographics
NPI:1952407876
Name:ANOOP PORWAL,MD PC
Entity Type:Organization
Organization Name:ANOOP PORWAL,MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANOOP
Authorized Official - Middle Name:
Authorized Official - Last Name:PORWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-276-2550
Mailing Address - Street 1:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1844
Mailing Address - Country:US
Mailing Address - Phone:732-276-2550
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:SUITE 17 A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-276-2550
Practice Address - Fax:732-874-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07772000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID NUMBER
NJ=========OtherTAX ID NUMBER
NJ086375Medicare ID - Type UnspecifiedMEDICARE #