Provider Demographics
NPI:1649267881
Name:STIEFEL, GREGORY G (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:STIEFEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 S DELSEA DR
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7042
Mailing Address - Country:US
Mailing Address - Phone:856-205-7071
Mailing Address - Fax:
Practice Address - Street 1:201 TOMLIN STATION RD
Practice Address - Street 2:STE B
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-1612
Practice Address - Country:US
Practice Address - Phone:856-241-2522
Practice Address - Fax:856-241-2511
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06817700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0859753000OtherAMERIHEALTH
7527221OtherAETNA PIN
2544170OtherAETNA/HMO
080179129OtherRR MEDICARE
NJ8247501Medicaid
NJ223772973OtherTAX ID
NJ8247501Medicaid
0859753000OtherAMERIHEALTH