Provider Demographics
NPI:1770697435
Name:SHARIT, FAY (DPM)
Entity type:Individual
Prefix:DR
First Name:FAY
Middle Name:
Last Name:SHARIT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3011
Mailing Address - Country:US
Mailing Address - Phone:201-286-5831
Mailing Address - Fax:
Practice Address - Street 1:155 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3011
Practice Address - Country:US
Practice Address - Phone:201-286-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00130500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084800Medicaid
5074000001Medicare NSC
T45059Medicare UPIN
NJ084800Medicaid