Provider Demographics
NPI:1164498333
Name:FREEDENFELD, STUART H (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:H
Last Name:FREEDENFELD
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 1:56 S MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559
Mailing Address - Country:US
Mailing Address - Phone:609-397-8585
Mailing Address - Fax:609-397-1907
Practice Address - Street 1:56 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559
Practice Address - Country:US
Practice Address - Phone:609-397-8585
Practice Address - Fax:609-397-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1286005Medicaid
C53232Medicare UPIN
NJ1286005Medicaid