Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MA39187 | NJ |
NPI | 1295766764 |
---|---|
Provider Name | Dr. Michael Fizicki |
First Address | East Rutherford, NJ 07073-1524 |
Second Address | East Rutherford, NJ 07073-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54711 | (02) | NJ |