Provider Demographics
NPI:1053373613
Name:PORWAL, ANOOP (MD)
Entity type:Individual
Prefix:
First Name:ANOOP
Middle Name:
Last Name:PORWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HOSPITAL DR
Mailing Address - Street 2:SUITE 17A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6434
Mailing Address - Country:US
Mailing Address - Phone:732-557-4444
Mailing Address - Fax:732-557-4445
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:SUITE 17A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-557-4444
Practice Address - Fax:732-557-4445
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07772000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223373283OtherTAX ID NUMBER
NJ870773444OtherTAX ID NUMBER
NJ086375CZGMedicare ID - Type UnspecifiedMEDICARE NUMBER
NJ870773444OtherTAX ID NUMBER