Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA04269600 | NJ |
NPI | 1114942398 |
---|---|
Provider Name | Steven Stoller |
First Address | Paramus, NJ 07652-1433 |
Second Address | Paramus, NJ 07652-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54180 | (02) | NJ |