Basic Information
| Provider Information | |||||||||
| NPI: | 1992775928 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RANGWALA | ||||||||
| FirstName: | ANIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2517 HIGHWAY 35 | ||||||||
| Address2: | BLDG M SUITE 101 | ||||||||
| City: | MANASQUAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087361918 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 JACK MARTIN BLVD | ||||||||
| Address2: | DEPT OF PATHOLOGY OCEAN MED CENTER | ||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328403218 | ||||||||
| FaxNumber: | 7324583851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 01/02/2008 | ||||||||
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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 | 207ZP0102X | 25MA03408800 | NJ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 8093504 | 05 | NJ | MEDICAID |