1871315390 NPI number — DR. CHALLIZ ANNE ENTRINA PUNLA DPT

Table of content: DR. CHALLIZ ANNE ENTRINA PUNLA DPT (NPI 1871315390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871315390 NPI number — DR. CHALLIZ ANNE ENTRINA PUNLA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUNLA
Provider First Name:
CHALLIZ ANNE
Provider Middle Name:
ENTRINA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871315390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 NEWMAN SPRINGS ROAD
Provider Second Line Business Mailing Address:
BLDG. 2, SUITE 220
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-807-0877
Provider Business Mailing Address Fax Number:
201-751-1680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 RARITAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07066-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
848-308-4515
Provider Business Practice Location Address Fax Number:
848-308-4516
Provider Enumeration Date:
10/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA01177400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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