Provider Demographics
NPI:1407853310
Name:FERGES, MITCHELL
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:FERGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLYDE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5032
Mailing Address - Country:US
Mailing Address - Phone:732-873-9200
Mailing Address - Fax:732-873-1699
Practice Address - Street 1:33 CLYDE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5032
Practice Address - Country:US
Practice Address - Phone:732-873-9200
Practice Address - Fax:732-873-1699
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03204300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110083490OtherRAILROAD MDCR #
NJ0K3007OtherHEALTHNET #
NJ4V5041OtherEMPIRE BC/BS E. BRUNS. #
NJTS058OtherOXFORD #
NJ0099027000OtherAMERIHEALTH #
NJ2499585OtherGHI PPO #
NJ1175203Medicaid
NJ2243283OtherAETNA HMO #
NJ15235OtherAMERICAID #
NJ4093715OtherAETNA PPO #
NJ40A653OtherEMPIRE BC/BS SOMERSET #
NJ110083490OtherRAILROAD MDCR #
NJC59943Medicare UPIN