Provider Demographics
NPI:1619939758
Name:CHAGARES, STEPHEN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:CHAGARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 EXECUTIVE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4933
Mailing Address - Country:US
Mailing Address - Phone:732-450-9700
Mailing Address - Fax:732-450-1511
Practice Address - Street 1:1 EXECUTIVE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4933
Practice Address - Country:US
Practice Address - Phone:732-450-9700
Practice Address - Fax:732-450-1511
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63076208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7030908Medicaid
881375Medicare PIN
NJG42549Medicare UPIN