Provider Demographics
NPI:1497105860
Name:STENVALL GROUP
Entity Type:Organization
Organization Name:STENVALL GROUP
Other - Org Name:SANFORD AVENUE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STENVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-214-2512
Mailing Address - Street 1:31 BIG SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830-3427
Mailing Address - Country:US
Mailing Address - Phone:973-214-2512
Mailing Address - Fax:908-832-6522
Practice Address - Street 1:31 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830-3427
Practice Address - Country:US
Practice Address - Phone:973-214-2512
Practice Address - Fax:908-832-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ10861261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental