Provider Demographics
NPI:1518941202
Name:BICKERTON, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BICKERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 SHREWSBURY AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4158
Mailing Address - Country:US
Mailing Address - Phone:732-741-5923
Mailing Address - Fax:732-741-2759
Practice Address - Street 1:595 SHREWSBURY AVE
Practice Address - Street 2:STE 103
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702
Practice Address - Country:US
Practice Address - Phone:732-741-5923
Practice Address - Fax:732-741-2759
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043967208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0334869000OtherAMERIHEALTH
NJ4403508OtherAETNA PPO
NJ0461614OtherAETNA HMO
NJ1000468OtherGHI PPO
NJ23D451OtherBCBS OF NY
NJ2456001Medicaid
NJ340012394OtherRAILROAD MEDICARE
NJ403211AWRMedicare PIN
NJ1000468OtherGHI PPO