Provider Demographics
NPI:1346571924
Name:STUMPO, STACEY (MED)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:STUMPO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 GLADWYN AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3667
Mailing Address - Country:US
Mailing Address - Phone:856-457-2210
Mailing Address - Fax:
Practice Address - Street 1:2630 GLADWYN AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3667
Practice Address - Country:US
Practice Address - Phone:856-457-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist