Provider Demographics
NPI:1578854394
Name:FONG, STEPHEN JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:FONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4071
Mailing Address - Country:US
Mailing Address - Phone:973-998-8828
Mailing Address - Fax:973-998-8830
Practice Address - Street 1:178 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4071
Practice Address - Country:US
Practice Address - Phone:973-998-8828
Practice Address - Fax:973-998-8830
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01392400174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist