Provider Demographics
NPI:1962438283
Name:FAER, MITCHELL HOWARD (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:HOWARD
Last Name:FAER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-772-8837
Mailing Address - Fax:973-772-8946
Practice Address - Street 1:267 PARKER AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-772-8837
Practice Address - Fax:973-772-8946
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00609200111N00000X
NYY0082371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U84387Medicare UPIN
NY05695Medicare ID - Type Unspecified
NJ076378Medicare ID - Type Unspecified