Provider Demographics
NPI:1891755336
Name:STAFFORD ORTHOPEDICS PA
Entity Type:Organization
Organization Name:STAFFORD ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-597-6092
Mailing Address - Street 1:1168 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2418
Mailing Address - Country:US
Mailing Address - Phone:609-597-6092
Mailing Address - Fax:609-597-7458
Practice Address - Street 1:1168 BEACON AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2418
Practice Address - Country:US
Practice Address - Phone:609-597-6092
Practice Address - Fax:609-597-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
161231Medicare ID - Type Unspecified
NJE27352Medicare UPIN
NJ4888970001Medicare NSC