Provider Demographics
NPI:1184764326
Name:FISHELBERG, GERALD NMI (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:NMI
Last Name:FISHELBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:NMI
Other - Last Name:FISHELBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:185 BLACKBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3757
Mailing Address - Country:US
Mailing Address - Phone:609-655-3803
Mailing Address - Fax:973-973-0328
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-7427
Practice Address - Fax:973-972-0328
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI008583001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics