Individual
MRS. MICHELLE FANOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
425 JACK MARTIN BLVD, BRICK, NJ 08724-7732
(732) 397-8630
(201) 365-5287
Mailing address
14 ALEXIS DR, FARMINGDALE, NJ 07727-3648
(732) 397-8630
(732) 397-8630
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MB09538400
NJ
207P00000X
Emergency Medicine Physician
OT012883&OS015355
PA
207Q00000X
Family Medicine Physician
25MB09538400
NJ
207Q00000X
Family Medicine Physician
OS015355&OT012883
PA
Other
Enumeration date
06/21/2009
Last updated
06/24/2025
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