Provider Demographics
NPI:1740229590
Name:FERNANDEZ, MICHAEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:FERNANDEZ
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 1:6295 OLD HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1558
Mailing Address - Country:US
Mailing Address - Phone:609-625-3100
Mailing Address - Fax:609-909-1212
Practice Address - Street 1:6295 OLD HARDING HWY
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-1558
Practice Address - Country:US
Practice Address - Phone:609-625-3100
Practice Address - Fax:609-909-1212
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC004355400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ003733STUMedicare PIN