Provider Demographics
NPI:1174649289
Name:STILLMAN, JONATHON SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:SCOTT
Last Name:STILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1130 MCBRIDE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3806
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:973-812-1404
Practice Address - Street 1:1825 STATE ROUTE 23
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7510
Practice Address - Country:US
Practice Address - Phone:973-633-1484
Practice Address - Fax:973-633-7980
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08217700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0202037Medicaid