1033114475 NPI number — STEFANO M STELLA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033114475 NPI number — STEFANO M STELLA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

STELLA

Provider First Name:

STEFANO

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1033114475

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/01/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 156

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FRANKLIN LAKES

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07417-0156

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

201-933-4775

Provider Business Mailing Address Fax Number:

201-935-0549

Provider First Line Business Practice Location Address:

71 UNION AVE

Provider Second Line Business Practice Location Address:

SUITE 101

Provider Business Practice Location Address City Name:

RUTHERFORD

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07070-1272

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

201-933-4775

Provider Business Practice Location Address Fax Number:

201-935-0549

Provider Enumeration Date:

06/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  25MA04443100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1961101 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 835C01 . This is a "EMPIRE BCBS OF NY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 11761 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1238279 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: BE000007401 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 305465 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 4244772 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1012274 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 3K3088 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: P798856 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0105342000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0296293 . This is a "GHI PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".