Provider Demographics
NPI:1972586204
Name:BURNS, STEPHEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:BURNS
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 1:460 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEA BRIGHT
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-2113
Mailing Address - Country:US
Mailing Address - Phone:732-741-5701
Mailing Address - Fax:
Practice Address - Street 1:179 AVENUE AT THE CMN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-460-9889
Practice Address - Fax:732-460-9859
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA036708002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2433001Medicaid
NJ2433001Medicaid
BU457287Medicare ID - Type Unspecified