Provider Demographics
NPI:1790985026
Name:STABLE, JOAQUIN J (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:J
Last Name:STABLE
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 1:1400 BLACKHORSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2096
Mailing Address - Country:US
Mailing Address - Phone:610-384-7711
Mailing Address - Fax:610-389-4353
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-380-4353
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA082867002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1666833OtherAETNA
3424261000OtherAMERIHEALTH, KEYSTONE, IBC
010046019OtherAMERICHOICE
NJ25MA08286700OtherNJ LICENSE
NJ118845 AVUMedicare PIN