Provider Demographics
NPI:1336234780
Name:STEMMER, SHLOMO M (MD)
Entity Type:Individual
Prefix:
First Name:SHLOMO
Middle Name:M
Last Name:STEMMER
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 1:807 HADDON AVE.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033
Mailing Address - Country:US
Mailing Address - Phone:856-428-6355
Mailing Address - Fax:856-428-6388
Practice Address - Street 1:807 HADDON AVE.
Practice Address - Street 2:SUITE 207
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:856-428-6355
Practice Address - Fax:856-428-6388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6669000Medicaid
NJ6669000Medicaid