Provider Demographics
NPI:1720547581
Name:ANIGHORO, MERCY (MD)
Entity type:Individual
Prefix:DR
First Name:MERCY
Middle Name:
Last Name:ANIGHORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MERCY
Other - Middle Name:
Other - Last Name:OGODO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:973-652-4356
Mailing Address - Fax:
Practice Address - Street 1:166 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2016
Practice Address - Country:US
Practice Address - Phone:973-926-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11499800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty