Provider Demographics
NPI:1265463574
Name:FISCHGRUND, EDDY N (DC)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:N
Last Name:FISCHGRUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PATRIOTS WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7426
Mailing Address - Country:US
Mailing Address - Phone:732-564-5508
Mailing Address - Fax:
Practice Address - Street 1:61 BEAVERBROOK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1748
Practice Address - Country:US
Practice Address - Phone:973-305-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC0018600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072461UNVMedicare PIN