Provider Demographics
NPI:1154314052
Name:REKANT, STANLEY IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:IRWIN
Last Name:REKANT
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 1:777 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2029
Mailing Address - Country:US
Mailing Address - Phone:609-567-0030
Mailing Address - Fax:609-567-0716
Practice Address - Street 1:777 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE A-2
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2029
Practice Address - Country:US
Practice Address - Phone:609-567-0030
Practice Address - Fax:609-567-0716
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA02729500207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109780Medicare ID - Type Unspecified
C53314Medicare UPIN