Provider Demographics
NPI:1013692839
Name:DWYER, MICHELLE S (CBS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:DWYER
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:S
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 MANCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2540
Mailing Address - Country:US
Mailing Address - Phone:201-554-2757
Mailing Address - Fax:201-971-4638
Practice Address - Street 1:444 MANCHESTER WAY
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2540
Practice Address - Country:US
Practice Address - Phone:201-554-2757
Practice Address - Fax:201-971-4638
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN