Provider Demographics
NPI:1508810748
Name:FUSFIELD, MICHAEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FUSFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:516 HIGH ST
Mailing Address - Street 2:UNIT 11
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1026
Mailing Address - Country:US
Mailing Address - Phone:609-267-2693
Mailing Address - Fax:609-267-5415
Practice Address - Street 1:516 HIGH ST
Practice Address - Street 2:UNIT 11
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1026
Practice Address - Country:US
Practice Address - Phone:609-267-2693
Practice Address - Fax:609-267-5415
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00108400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0668702Medicaid
NJT77738Medicare UPIN
NJ004435UK7Medicare ID - Type Unspecified