Provider Demographics
NPI:1710526363
Name:STEVENS, ANDREW LEE
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:STEVENS
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 1:9 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2033
Mailing Address - Country:US
Mailing Address - Phone:856-412-0630
Mailing Address - Fax:
Practice Address - Street 1:1160 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2802
Practice Address - Country:US
Practice Address - Phone:856-412-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging