Provider Demographics
NPI:1790781094
Name:HONICKMAN, STEVEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:HONICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579A CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-390-1856
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25039994002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ300102247OtherRAILROAD MEDICARE - WARREN
NJ300025883OtherRAILROAD MEDICARE - BRIDGEWATER
NJ300102247OtherRAILROAD MEDICARE - SMC
NJ0650706Medicaid
NJ300009499OtherRAILROAD MEDICARE - EDISON
NJ300009499OtherRAILROAD MEDICARE - EDISON
NJHO448421Medicare ID - Type Unspecified