Provider Demographics
NPI:1982686952
Name:STENNETT, RICHARD (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STENNETT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18086
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8086
Mailing Address - Country:US
Mailing Address - Phone:201-943-5991
Mailing Address - Fax:201-943-8733
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:800-991-9133
Practice Address - Fax:201-943-8733
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64072207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8572909Medicaid
NJ888595Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER