Provider Demographics
NPI:1780574038
Name:FANOR, JIMMY
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:FANOR
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 1:201 DELACY DR
Mailing Address - Street 2:JISHERLLC@GMAIL.COM
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-0706
Mailing Address - Country:US
Mailing Address - Phone:862-250-4400
Mailing Address - Fax:
Practice Address - Street 1:201 DELACY DR
Practice Address - Street 2:JISHERLLC@GMAIL.COM
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-0706
Practice Address - Country:US
Practice Address - Phone:862-250-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist