Provider Demographics
NPI:1669573861
Name:STAVRELLIS, STEVE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:JOHN
Last Name:STAVRELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21 S HOPE CHAPEL RD STE 131
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5000
Mailing Address - Country:US
Mailing Address - Phone:732-363-1424
Mailing Address - Fax:732-370-0714
Practice Address - Street 1:21 S HOPE CHAPEL RD STE 131
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5000
Practice Address - Country:US
Practice Address - Phone:732-363-1424
Practice Address - Fax:732-370-0714
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA02835000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1299301Medicaid