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General NPI Number Information
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NPI Number | 1164461919
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Entity Type | Individual
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Provider Name | DONALD JOSEPH FEDORYK D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 312 COURTYARD DR
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4253
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Country | US
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Telephone | 908-722-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 1387 KNIGHTSBRIDGE RD
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2704
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Country | US
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Telephone | 908-722-9075
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00180400
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License Number State | NJ
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