Provider Demographics
NPI:1740618347
Name:STELLA, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:STELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 BOXWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1758
Mailing Address - Country:US
Mailing Address - Phone:201-323-7473
Mailing Address - Fax:
Practice Address - Street 1:4305 BOXWOOD CT
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1758
Practice Address - Country:US
Practice Address - Phone:201-323-7473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00510500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist