Individual
MICHELE E FANTASIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 SOMERSET ST, NEW BRUNSWICK, NJ 08901-1942
(732) 258-7000
(908) 301-5456
Mailing address
150 NEW PROVIDENCE RD, MOUNTAINSIDE, NJ 07092-2590
(908) 301-5404
(908) 301-5456
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
25MA06336800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01000313201
AMERICHOICE NJ
NJ
01
—
0125682
CIGNA HEALTHCARE
NJ
01
—
1096732
HORIZON NJ HEALTH
NJ
01
—
2119078000
AMERIHEALTH
NJ
01
—
221487148
DEVON HEALTHCARE
NJ
01
—
221487148-016
QUALCARE INC
NJ
01
—
2300074
AETNA HEALTHCARE
NJ
01
—
24225
UNIVERSITY HEALTH PLAN
NJ
01
—
2K3684
HEALTHNET
NJ
01
—
54027
AMERIGROUP
NJ
01
—
P2122543
OXFORD
NJ
01
—
S51B01
EMPIRE
NJ
Enumeration date
02/23/2006
Last updated
08/24/2010
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