Provider Demographics
NPI:1548238280
Name:FALLEK, STEVE R (MD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:R
Last Name:FALLEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-759-8005
Mailing Address - Fax:973-759-7545
Practice Address - Street 1:300 SYLVAN AVE
Practice Address - Street 2:STE 301
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07632-2525
Practice Address - Country:US
Practice Address - Phone:201-541-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060121002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7720505Medicaid
G81157Medicare UPIN
NJ7720505Medicaid
NY40L881Medicare PIN