Basic Information
| Provider Information | |||||||||
| NPI: | 1932689528 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | SHAHRYAR | ||||||||
| MiddleName: | ANWAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 NOTTINGHILL LN | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086194005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095755766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086291915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101268554 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.