Provider Demographics
NPI:1225042278
Name:STABILE, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:STABILE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 DEAN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2762
Mailing Address - Country:US
Mailing Address - Phone:201-567-5995
Mailing Address - Fax:201-567-1354
Practice Address - Street 1:111 DEAN DR STE 2
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2762
Practice Address - Country:US
Practice Address - Phone:201-567-5995
Practice Address - Fax:201-567-1354
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA36571207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4841506Medicaid
NJE51262Medicare UPIN
NJ441310BGFMedicare ID - Type Unspecified