Basic Information
| Provider Information | |||||||||
| NPI: | 1144320128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TANWIR | ||||||||
| FirstName: | ANJUM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2168 MILLBURN AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070402640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737623353 | ||||||||
| FaxNumber: | 9737623370 | ||||||||
| Practice Location | |||||||||
| Address1: | 2168 MILLBURN AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | MAPLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070402640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737623353 | ||||||||
| FaxNumber: | 9737623370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA08116700 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 25MA08116700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P00855694 | 01 | NJ | RAILROAD MEDICARE | OTHER | 0120383 | 05 | NJ | MEDICAID | 91002822900 | 01 | NJ | AMERICHOICE | OTHER |