Provider Demographics
NPI:1891006078
Name:MUNN, STEPHANIE V (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:V
Last Name:MUNN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4026
Mailing Address - Country:US
Mailing Address - Phone:516-884-8668
Mailing Address - Fax:
Practice Address - Street 1:686 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4026
Practice Address - Country:US
Practice Address - Phone:732-262-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00238500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0351679Medicaid