Provider Demographics
NPI:1033296926
Name:STANLEY KLUGHAUPT MD PA
Entity Type:Organization
Organization Name:STANLEY KLUGHAUPT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THADANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-447-4447
Mailing Address - Street 1:50 NEWARK AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1185
Mailing Address - Country:US
Mailing Address - Phone:973-450-0220
Mailing Address - Fax:973-450-0162
Practice Address - Street 1:50 NEWARK AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1185
Practice Address - Country:US
Practice Address - Phone:973-450-0220
Practice Address - Fax:973-450-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7965401Medicaid
NJE13233Medicare UPIN
NJ7965401Medicaid