Provider Demographics
NPI:1326121195
Name:FEDICH, JAMES ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:FEDICH
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 1:773 ROUTE 517, VILLAGE SQUARE MALL
Mailing Address - Street 2:PO BOX 333
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820
Mailing Address - Country:US
Mailing Address - Phone:908-813-8200
Mailing Address - Fax:
Practice Address - Street 1:773 ROUTE 517, VILLAGE SQUARE MALL
Practice Address - Street 2:VILLAGE SQUARE @ PANTHER VALLEY
Practice Address - City:ALLAMUCHY
Practice Address - State:NJ
Practice Address - Zip Code:07820
Practice Address - Country:US
Practice Address - Phone:908-813-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00621900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079218SR6Medicare PIN