Provider Demographics
NPI:1265462733
Name:DUCEY, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:DUCEY
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 1:45 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3224
Mailing Address - Country:US
Mailing Address - Phone:973-751-0111
Mailing Address - Fax:973-235-0110
Practice Address - Street 1:45 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3224
Practice Address - Country:US
Practice Address - Phone:973-751-0111
Practice Address - Fax:973-235-0110
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ052748Medicare ID - Type UnspecifiedMEDICARE ID
NJG91542Medicare UPIN
NJ5169930001Medicare NSC