Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA08180400 | NJ |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA08180400 | NJ |
NPI | 1366502163 |
---|---|
Provider Name | Dr. Anshu Bhalla |
First Address | Monroe, NJ 08831-1564 |
Second Address | Monroe, NJ 08831-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 26/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I67162 | (02) | NJ |