Provider Demographics
NPI:1821235136
Name:JOEL G. FISCHGRUND M.D.P.A.
Entity Type:Organization
Organization Name:JOEL G. FISCHGRUND M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:FISCHGRUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-696-6687
Mailing Address - Street 1:61 BEAVERBROOK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1748
Mailing Address - Country:US
Mailing Address - Phone:973-696-6687
Mailing Address - Fax:973-696-2260
Practice Address - Street 1:61 BEAVERBROOK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1748
Practice Address - Country:US
Practice Address - Phone:973-696-6687
Practice Address - Fax:973-696-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03627500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56405Medicare UPIN