Provider Demographics
NPI:1063935641
Name:BAGCHI, ANN DALTON (PHD, DNP)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:DALTON
Last Name:BAGCHI
Suffix:
Gender:F
Credentials:PHD, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4752
Mailing Address - Country:US
Mailing Address - Phone:201-303-6101
Mailing Address - Fax:
Practice Address - Street 1:2204 US HIGHWAY 130 STE C3
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4805
Practice Address - Country:US
Practice Address - Phone:732-821-5151
Practice Address - Fax:732-444-5955
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00747200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily