Provider Demographics
NPI:1770686289
Name:FERDINAND, MICHEL-ANGE (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL-ANGE
Middle Name:
Last Name:FERDINAND
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 1:115 JEFFERSON AVE
Mailing Address - Street 2:PO BOX 470
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-351-6663
Mailing Address - Fax:903-351-1760
Practice Address - Street 1:115 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-351-6663
Practice Address - Fax:903-351-1760
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62196207Q00000X
NJ25MA41866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8654506Medicaid
D06441Medicare UPIN
NJ8654506Medicaid