Provider Demographics
NPI:1871665760
Name:FITZGERALD, MICHAEL W (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:FITZGERALD
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 1:342 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2554
Mailing Address - Country:US
Mailing Address - Phone:973-790-3181
Mailing Address - Fax:973-790-0672
Practice Address - Street 1:342 UNION BLVD
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2554
Practice Address - Country:US
Practice Address - Phone:973-790-3181
Practice Address - Fax:973-790-0672
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ450721Medicare ID - Type Unspecified
NJT45152Medicare UPIN
NJ450721Medicare PIN