Healthcare Provider Details

I. General information

NPI: 1568454031
Provider Name (Legal Business Name): ALAN S FIERVERKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINCOLN AVE
CARBONDALE PA
18407-2116
US

IV. Provider business mailing address

66 W GILBERT ST SUITE 100
TINTON FALLS NJ
07701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 570-281-1004
  • Fax:
Mailing address:
  • Phone: 732-212-0060
  • Fax: 732-212-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD039971E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: