Provider Demographics
NPI:1285665034
Name:KJELLBERG, STEN I (MD)
Entity Type:Individual
Prefix:MR
First Name:STEN
Middle Name:I
Last Name:KJELLBERG
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:224 ROSEBERRY STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1687
Practice Address - Country:US
Practice Address - Phone:908-859-5222
Practice Address - Fax:908-859-3261
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06791900208600000X
PAMD051108L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7143109Medicaid
NJ7143109Medicaid
G39598Medicare UPIN