Fantazzio, Michele

Fantazzio, Michele is an individual health care provider with primary practice located at 2 Cooper Plz , Camden NJ 08103-1461. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Fantazzio, Michele can be contacted via phone (855) 632-2667.

Contact Information

Primary practice address
2 Cooper Plz Camden NJ 08103-1461
Phone: (855) 632-2667
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 25MA07253200 New Jersey

Profile Details

NPI number 1326036245
LBN Legal business name Fantazzio, Michele
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2005
Last updated Sep 29th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326036245 NPPES
New Jersey MEDICAID 8774501

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