MEDICARE: MICHAL R FRUCHTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DIO2287300	NJ

General Provider Information

NPI Number	:	1356432173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL R FRUCHTER

Provider Business Mailing Address
First Line	:	475 SOUTH PKWY
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1244
Country	:	US
Telephone Number	:	973-249-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 SOUTH PKWY
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1244
Country	:	US
Telephone Number	:	973-249-8107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/04/2008

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Directions to “ MICHAL R FRUCHTER ” Practice Location

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