Provider Demographics
NPI:1295766764
Name:FIZICKI, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FIZICKI
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 1:192 HACKENSACK ST
Mailing Address - Street 2:UNIT G
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1524
Mailing Address - Country:US
Mailing Address - Phone:201-460-8282
Mailing Address - Fax:302-371-6655
Practice Address - Street 1:192 HACKENSACK ST
Practice Address - Street 2:UNIT G
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1524
Practice Address - Country:US
Practice Address - Phone:201-460-8282
Practice Address - Fax:302-371-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39187207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54711Medicare UPIN
NJF444829Medicare ID - Type Unspecified