Provider Demographics
NPI:1790799492
Name:FOSCHETTI, FELIX PHILLIP JR (DO)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:PHILLIP
Last Name:FOSCHETTI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 BUTLERS PARK RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2470
Mailing Address - Country:US
Mailing Address - Phone:908-689-7171
Mailing Address - Fax:
Practice Address - Street 1:23 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2000
Practice Address - Country:US
Practice Address - Phone:908-689-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02638600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54500Medicare UPIN
426958Medicare ID - Type Unspecified