Provider Demographics
NPI:1558434308
Name:KOERNER, STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KOERNER
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 1:1301 ROUTE 72 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2417
Mailing Address - Country:US
Mailing Address - Phone:609-597-6513
Mailing Address - Fax:609-597-4593
Practice Address - Street 1:1301 ROUTE 72 W
Practice Address - Street 2:SUITE 300
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2417
Practice Address - Country:US
Practice Address - Phone:609-597-6513
Practice Address - Fax:609-597-4593
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB55609207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0411885003OtherCIGNA
NJ223012814OtherQUALCARE
NJ6203001Medicaid
NJF01493OtherHEALTH NET
NJ0714723000OtherAMERIHEALTH
NJ223012814OtherDEVON
NJ223012814OtherATLANTICARE
NJ223012814OtherHORIZON
NJ223012814OtherHORIZON
NJ0714723000OtherAMERIHEALTH