Healthcare Provider Details

I. General information

NPI: 1063877686
Provider Name (Legal Business Name): LOVERTON FIDEL M.A., M.S., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2015
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CORNWALL CT STE B
EAST BRUNSWICK NJ
08816-3347
US

IV. Provider business mailing address

1430 ROUTE 27
NORTH BRUNSWICK NJ
08902-1538
US

V. Phone/Fax

Practice location:
  • Phone: 732-955-4141
  • Fax:
Mailing address:
  • Phone: 732-247-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00596700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: