Individual
FATU BANGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65-67 MELVILLE PLACE, IRVINGTON, NJ 07111
(862) 777-3526
Mailing address
65-67 MELVILLE PLACE, IRVINGTON, NJ 07111
(862) 777-3526
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
251X00000X
Supports Brokerage Agency
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
05/21/2021
Last updated
05/21/2021
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