Provider Demographics
NPI:1386961704
Name:BELLISH, MICHAEL LEE
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:BELLISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3050
Mailing Address - Country:US
Mailing Address - Phone:732-679-1056
Mailing Address - Fax:732-952-3665
Practice Address - Street 1:95 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-2901
Practice Address - Country:US
Practice Address - Phone:732-505-8784
Practice Address - Fax:732-505-1598
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02857000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist