Provider Demographics
NPI:1073708236
Name:STAFFORD, FRANK J I (APN)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:J
Last Name:STAFFORD
Suffix:I
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 CHAPEL AVE W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2051
Mailing Address - Country:US
Mailing Address - Phone:856-482-9000
Mailing Address - Fax:856-482-1159
Practice Address - Street 1:2250 CHAPEL AVE W
Practice Address - Street 2:CHERRY HILL
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2051
Practice Address - Country:US
Practice Address - Phone:856-482-9000
Practice Address - Fax:856-482-1159
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00129900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0177555Medicaid
NJP00755957OtherRAILROAD MEDICARE
NJ135917A0YMedicare PIN