Healthcare Provider Details

I. General information

NPI: 1164420352
Provider Name (Legal Business Name): MICHELE DAVIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 CRANBURY RD UNIT 81
EAST BRUNSWICK NJ
08816-8004
US

IV. Provider business mailing address

614 CRANBURY RD UNIT 81
EAST BRUNSWICK NJ
08816-8004
US

V. Phone/Fax

Practice location:
  • Phone: 908-360-5362
  • Fax:
Mailing address:
  • Phone: 908-451-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236461
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07472100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: