Provider Demographics
NPI:1558461947
Name:STEIN, IRA M (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:M
Last Name:STEIN
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 1:661 MACEDONIA DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8012
Mailing Address - Country:US
Mailing Address - Phone:609-402-6989
Mailing Address - Fax:
Practice Address - Street 1:1102 ATLANTIC AVE
Practice Address - Street 2:LEONARD ERBER MEDICAL CENTER
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-345-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06188900207RH0002X, 207R00000X
NJMA061889207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6642501Medicaid
C09587Medicare UPIN
NJ791536CN9Medicare PIN
NJ6642501Medicaid