1023130895 NPI number — DR. R. LINCOLN STOLBER D.D.S.

Table of content: DR. R. LINCOLN STOLBER D.D.S. (NPI 1023130895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023130895 NPI number — DR. R. LINCOLN STOLBER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLBER
Provider First Name:
R.
Provider Middle Name:
LINCOLN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023130895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 BEACON HILL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-753-1547
Provider Business Mailing Address Fax Number:
856-753-1548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
339 N ROUTE 73
Provider Second Line Business Practice Location Address:
WINSLOW PROF. BLDG. SUITE 4
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08009-9707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-753-1547
Provider Business Practice Location Address Fax Number:
856-753-1548
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22DI01021800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)