Doctor Name: | MRS. MARY ANN E MICHELIS |
NPI Number: | 1710956073 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 25MA03935600 |
Business Practice Address: | 360 Essex Street Suite 302 Hackensack, NJ - 07601 |
Business Phone Number: | 5519962065 |
Business Fax Number: | 5519962169 |
Mailing Address: | 360 Essex Street, Suite 302 HACKENSACK |
State: | NJ |
Postal Code: | 07601 |
Phone Number: | 5519962065 |
Fax Number: | 5519962169 |
NPI Enumeration Date: | 03/17/2006 |
NPI Last Update Date: | 07/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 25MA03935600 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |