Provider Demographics
NPI:1548341613
Name:ANDERSON-WRIGHT, PHYLLIS (DO)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:
Last Name:ANDERSON-WRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 BERCKMAN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1813
Mailing Address - Country:US
Mailing Address - Phone:908-723-2311
Mailing Address - Fax:
Practice Address - Street 1:835 ROOSEVELT AVE
Practice Address - Street 2:PLAZA 12 SUITE 4A
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1815
Practice Address - Country:US
Practice Address - Phone:732-969-2240
Practice Address - Fax:732-969-2152
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB65551207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7762402Medicaid
NJ024276Medicare ID - Type Unspecified
NJ7762402Medicaid