Provider Demographics
NPI:1982671830
Name:FELLMAN, DAMON M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:M
Last Name:FELLMAN
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 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-488-1515
Mailing Address - Fax:201-488-9471
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-488-1515
Practice Address - Fax:201-488-9471
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63069Medicare UPIN