Provider Demographics
NPI:1275875437
Name:HADDAD, STEPHANIE I (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:I
Last Name:HADDAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JULIA WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1308
Mailing Address - Country:US
Mailing Address - Phone:732-735-8475
Mailing Address - Fax:
Practice Address - Street 1:10 JULIA WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1308
Practice Address - Country:US
Practice Address - Phone:732-735-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129066207P00000X
NY290006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine