Provider Demographics
NPI:1770531873
Name:STEPHENSON, KAREN (MD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2415
Mailing Address - Country:US
Mailing Address - Phone:973-434-9944
Mailing Address - Fax:732-937-5358
Practice Address - Street 1:88 HIGH ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2415
Practice Address - Country:US
Practice Address - Phone:917-913-3578
Practice Address - Fax:732-937-5358
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215077207P00000X, 207R00000X
NJ25MA07917900207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184370Medicaid
NY037AA1Medicare PIN
NY02184370Medicaid
H53939Medicare UPIN