Provider Demographics
NPI:1376761262
Name:STANLEY, LINDA (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 N FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2547
Mailing Address - Country:US
Mailing Address - Phone:609-272-0655
Mailing Address - Fax:609-272-9188
Practice Address - Street 1:331 JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205
Practice Address - Country:US
Practice Address - Phone:609-652-6016
Practice Address - Fax:609-652-2406
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA40860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2211009Medicaid
NJC52715Medicare UPIN
NJ2211009Medicaid