Provider Demographics
NPI:1033114475
Name:STELLA, STEFANO M (MD)
Entity Type:Individual
Prefix:
First Name:STEFANO
Middle Name:M
Last Name:STELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-0156
Mailing Address - Country:US
Mailing Address - Phone:201-933-4775
Mailing Address - Fax:201-935-0549
Practice Address - Street 1:71 UNION AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1272
Practice Address - Country:US
Practice Address - Phone:201-933-4775
Practice Address - Fax:201-935-0549
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04443100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1961101Medicaid
NJ835C01OtherEMPIRE BCBS OF NY
NJ11761OtherUNIVERSITY HEALTH PLANS
NJ1238279OtherAETNA HMO
NJBE000007401OtherAMERICHOICE
NJ305465OtherAMERIGROUP
NJ4244772OtherAETNA PPO
NJ1012274OtherHORIZON NJ HEALTH
NJ3K3088OtherHEALTHNET
NJP798856OtherOXFORD
NJ0105342000OtherAMERIHEALTH
NJ0296293OtherGHI PPO
NJ1961101Medicaid
NJ11761OtherUNIVERSITY HEALTH PLANS
NJC55724Medicare UPIN