Provider Demographics
NPI:1184712879
Name:PODOB, STUART JEFFREY (DC)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:JEFFREY
Last Name:PODOB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1253
Mailing Address - Country:US
Mailing Address - Phone:732-363-7900
Mailing Address - Fax:732-363-9341
Practice Address - Street 1:1700 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1253
Practice Address - Country:US
Practice Address - Phone:732-363-7900
Practice Address - Fax:732-363-9341
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO8671-2Medicare ID - Type Unspecified