Provider Demographics
NPI:1164745428
Name:STACK, NORMAN J (VMD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:J
Last Name:STACK
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2605
Mailing Address - Country:US
Mailing Address - Phone:973-763-3445
Mailing Address - Fax:973-763-2819
Practice Address - Street 1:2172 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2605
Practice Address - Country:US
Practice Address - Phone:973-763-3445
Practice Address - Fax:973-763-2819
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01167174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian