Provider Demographics
NPI:1043344716
Name:STABILE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STABILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WHITEHORSE MERCERVILLE RD STE 218
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3835
Mailing Address - Country:US
Mailing Address - Phone:609-689-5760
Mailing Address - Fax:609-689-5759
Practice Address - Street 1:1401 WHITEHORSE MERCERVILLE RD STE 218
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3835
Practice Address - Country:US
Practice Address - Phone:609-689-5760
Practice Address - Fax:609-689-5759
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1517007Medicaid
452338VAFMedicare ID - Type Unspecified