1962572073 NPI number — DR. STEPHANIE E. SNEAD POELLNITZ M.D.

Table of content: DR. STEPHANIE E. SNEAD POELLNITZ M.D. (NPI 1962572073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962572073 NPI number — DR. STEPHANIE E. SNEAD POELLNITZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SNEAD POELLNITZ
Provider First Name:
STEPHANIE
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNEAD-POELLNITZ
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962572073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 DELANCY CT
Provider Second Line Business Mailing Address:
P.O. BOX 842
Provider Business Mailing Address City Name:
MAYS LANDING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08330-3442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-703-1999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 BETHEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERS POINT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08244-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-365-2601
Provider Business Practice Location Address Fax Number:
609-365-2519
Provider Enumeration Date:
11/08/2006

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: 2084P0800X , with the licence number:  25MA06388600 , 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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