Provider Demographics
NPI:1518956002
Name:SMALL, STEPHEN EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:SMALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 LAKEHURST RD STE 301
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7388
Mailing Address - Country:US
Mailing Address - Phone:732-255-7155
Mailing Address - Fax:732-255-7455
Practice Address - Street 1:413 LAKEHURST RD STE 301
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-255-7155
Practice Address - Fax:732-255-7455
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008382208200000X
NJ25MB07162600208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2806037000OtherAMERIHEALTH
NJ3K4764OtherHEALTHNET
NJ9453528OtherPHCS
204999183OtherHORIZON
NJ7843763OtherAETNA
NJ8318425OtherCIGNA
NJ0116220Medicaid
NJ8318425OtherCIGNA
NJ0116220Medicaid
H58191Medicare UPIN