Provider Demographics
NPI:1124145289
Name:ANWAR, ROMILLA (MD)
Entity type:Individual
Prefix:DR
First Name:ROMILLA
Middle Name:
Last Name:ANWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5A HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2966
Mailing Address - Country:US
Mailing Address - Phone:917-586-7586
Mailing Address - Fax:
Practice Address - Street 1:4012 80TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1234
Practice Address - Country:US
Practice Address - Phone:718-426-9595
Practice Address - Fax:718-426-2729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195639-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist