Provider Demographics
NPI:1457439473
Name:STEIN, IRA M (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:STEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:IRA
Other - Middle Name:M
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1070 STATE ROUTE 34
Mailing Address - Street 2:SUITE U
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3469
Mailing Address - Country:US
Mailing Address - Phone:732-888-0110
Mailing Address - Fax:
Practice Address - Street 1:1070 STATE ROUTE 34
Practice Address - Street 2:SUITE U
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3469
Practice Address - Country:US
Practice Address - Phone:732-888-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1895213E00000X
NYN4517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP50311OtherEMPIRE
NJ0951706Medicaid
NJMD1895OtherLICENSE
NJ0034841OtherGHI
NJ0034841OtherGHI
NJMD1895OtherLICENSE
NJ0951706Medicaid