Healthcare Provider Details

I. General information

NPI: 1740229590
Provider Name (Legal Business Name): MICHAEL A FERNANDEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6295 OLD HARDING HWY
MAYS LANDING NJ
08330-1558
US

IV. Provider business mailing address

6295 OLD HARDING HWY
MAYS LANDING NJ
08330-1558
US

V. Phone/Fax

Practice location:
  • Phone: 609-625-3100
  • Fax: 609-909-1212
Mailing address:
  • Phone: 609-625-3100
  • Fax: 609-909-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC004355400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: