1215967559 NPI number — BILL E. STEFANOU DC

Table of content: BILL E. STEFANOU DC (NPI 1215967559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215967559 NPI number — BILL E. STEFANOU DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFANOU
Provider First Name:
BILL
Provider Middle Name:
E.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1215967559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CHURCH ROAD
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:
08053-9410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-983-8282
Provider Business Mailing Address Fax Number:
856-596-7462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 CHURCH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053-9410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-983-8282
Provider Business Practice Location Address Fax Number:
856-596-7462
Provider Enumeration Date:
07/03/2006

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: 111N00000X , with the licence number:  38MC00228700 , 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: 43849 . This is a "AETNA ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: SB263088 . This is a "GHI INS." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 736820 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P413019 . This is a "OXFORD HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-2828991 . This is a "TID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 610453800 . This is a "US DEPT OF LABOR / OWCP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0101867000 . This is a "AMERIHEALTH/KEYSTONE HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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