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General NPI Number Information
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NPI Number | 1770686289
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Entity Type | Individual
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Provider Name | MICHEL-ANGE FERDINAND MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 115 JEFFERSON AVE
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City | ELIZABETH
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State | NJ
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Zip | 07201
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Country | US
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Telephone | 908-351-6663
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Fax | 903-351-1760
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Provider Business Mailing Address
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Address Line | 115 JEFFERSON AVE PO BOX 470
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City | ELIZABETH
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State | NJ
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Zip | 07201
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Country | US
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Telephone | 908-351-6663
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Fax | 903-351-1760
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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 | ME62196
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License Number State | FL
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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 | 25MA41866
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License Number State | NJ
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