Provider Demographics
NPI:1881215929
Name:FOX, MICHAEL JONATHAN (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:FOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 RTE 202/206
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1746
Mailing Address - Country:US
Mailing Address - Phone:087-048-7789
Mailing Address - Fax:
Practice Address - Street 1:720 RTE 202/206
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1746
Practice Address - Country:US
Practice Address - Phone:908-704-8778
Practice Address - Fax:908-704-8172
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00375300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery