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General NPI Number Information
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NPI Number | 1164420352
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Entity Type | Individual
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Provider Name | MICHELE DAVIS D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 614 CRANBURY RD UNIT 81
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-8004
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Country | US
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Telephone | 908-360-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 614 CRANBURY RD UNIT 81
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-8004
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Country | US
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Telephone | 908-451-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 236461
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB07472100
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License Number State | NJ
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