Provider Demographics
NPI:1033180781
Name:CHRISTIAN, STEPHENIA D (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHENIA
Middle Name:D
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 CENTRAL AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1951
Mailing Address - Country:US
Mailing Address - Phone:973-678-8288
Mailing Address - Fax:973-678-0731
Practice Address - Street 1:576 CENTRAL AVE
Practice Address - Street 2:STE 200A
Practice Address - City:E ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-678-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00201000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5463106Medicaid
NJ5463106Medicaid
5741410001Medicare NSC
U12783Medicare UPIN