Provider Demographics
NPI:1689742025
Name:CHURCHILL, STEPHEN KNOWLES
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KNOWLES
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 OAKDENE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2039
Mailing Address - Country:US
Mailing Address - Phone:201-947-4862
Mailing Address - Fax:201-833-1390
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-833-1333
Practice Address - Fax:201-833-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO3114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist