Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA06616400 | NJ |
NPI | 1053309195 |
---|---|
Provider Name | Jonathan L Fellus |
First Address | Flanders, NJ 07836 |
Second Address | Flanders, NJ 07836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 10/04/2013 |