Provider Demographics
NPI:1487185831
Name:DEFELICE, STEPHEN E SR
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:DEFELICE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 GERALDINE CT
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9156
Mailing Address - Country:US
Mailing Address - Phone:732-757-5097
Mailing Address - Fax:732-655-1081
Practice Address - Street 1:1905 GERALDINE CT
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9156
Practice Address - Country:US
Practice Address - Phone:732-757-5097
Practice Address - Fax:732-655-1081
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00413300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor