Provider Demographics
NPI:1437233343
Name:GARRY, MICHAEL P
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:GARRY
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 1:7 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801-2016
Mailing Address - Country:US
Mailing Address - Phone:908-534-1010
Mailing Address - Fax:908-534-1060
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3691
Practice Address - Country:US
Practice Address - Phone:908-534-1010
Practice Address - Fax:908-534-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00254000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2192004Medicaid
NJGA758303RTJMedicare ID - Type Unspecified
NJT77776Medicare UPIN