1215937354 NPI number — MICHAEL STEWART STANLEY PA-C

Table of content: MICHAEL STEWART STANLEY PA-C (NPI 1215937354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215937354 NPI number — MICHAEL STEWART STANLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANLEY
Provider First Name:
MICHAEL
Provider Middle Name:
STEWART
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1215937354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 N VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERS POINT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08244-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-404-0340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAPE MAY USCG CLINIC
Provider Second Line Business Practice Location Address:
1 MUNRO AVE
Provider Business Practice Location Address City Name:
CAPE MAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-898-6436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2005

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: 363A00000X , with the licence number:  PA581 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 25MP00701300 , 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: 50073444 . This is a "PASSPORT MANAGED MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 9500251500 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".