1649267881 NPI number — GREGORY G STIEFEL D.O.

Table of content: GREGORY G STIEFEL D.O. (NPI 1649267881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649267881 NPI number — GREGORY G STIEFEL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIEFEL
Provider First Name:
GREGORY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1649267881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2848 S DELSEA DR
Provider Second Line Business Mailing Address:
SUITE 4B
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-7042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-205-7071
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 TOMLIN STATION RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
MULLICA HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08062-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-241-2522
Provider Business Practice Location Address Fax Number:
856-241-2511
Provider Enumeration Date:
10/03/2005

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: 207Q00000X , with the licence number:  MB06817700 , 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)

  • Identifier: 0859753000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7527221 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2544170 . This is a "AETNA/HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080179129 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8247501 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223772973 . This is a "TAX ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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