Basic Information
| Provider Information | |||||||||
| NPI: | 1568555290 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE BETHANY ROAD | ||||||||
| Address2: | BUILDING 5 SUITE 65 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322640700 | ||||||||
| FaxNumber: | 7322641414 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE BETHANY ROAD | ||||||||
| Address2: | BUILDING 5 SUITE 65 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322640700 | ||||||||
| FaxNumber: | 7322641414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MB08014500 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 25MB08014500 | 01 | NJ | MEDICAL LICENSE | OTHER |