Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | MD00111300 | NJ |
NPI | 1235191875 |
---|---|
Provider Name | Michael J. Felicetta |
First Address | Toms River, NJ 08753-2978 |
Second Address | Toms River, NJ 08755-4920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 23/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0990906 | (05) | NJ |
T73058 | (02) | NJ |