1417149816 NPI number — MR. STAFFORD WENDELL BARTON LPC

Table of content: MR. STAFFORD WENDELL BARTON LPC (NPI 1417149816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417149816 NPI number — MR. STAFFORD WENDELL BARTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTON
Provider First Name:
STAFFORD
Provider Middle Name:
WENDELL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1417149816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/23/2020
NPI Reactivation Date:
05/12/2025

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 WANAQUE AVE
Provider Second Line Business Mailing Address:
SECOND FLOOR (LTC)
Provider Business Mailing Address City Name:
POMPTON LAKES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07442-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-718-4344
Provider Business Mailing Address Fax Number:
973-718-4344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 WANAQUE AVE
Provider Second Line Business Practice Location Address:
SECOND FLOOR (LTC)
Provider Business Practice Location Address City Name:
POMPTON LAKES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07442-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-718-4344
Provider Business Practice Location Address Fax Number:
973-718-4344
Provider Enumeration Date:
08/10/2007

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: 101YP2500X , with the licence number:  37PC00329600 , 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)





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