Provider Demographics
NPI:1649472481
Name:STEN I. KJELLBERG,MD,PA
Entity type:Organization
Organization Name:STEN I. KJELLBERG,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:908-859-5222
Mailing Address - Street 1:224 ROSEBERRY ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1687
Mailing Address - Country:US
Mailing Address - Phone:908-859-5222
Mailing Address - Fax:908-859-3261
Practice Address - Street 1:224 ROSEBERRY ST UNIT 8
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1687
Practice Address - Country:US
Practice Address - Phone:908-859-5222
Practice Address - Fax:908-859-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06791900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7143109Medicaid
NJ7143109Medicaid
NJ122532Medicare PIN