Provider Demographics
NPI:1841450616
Name:STEPHEN E PAUL DO PA
Entity type:Organization
Organization Name:STEPHEN E PAUL DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-779-9220
Mailing Address - Street 1:111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2679
Mailing Address - Country:US
Mailing Address - Phone:856-779-9220
Mailing Address - Fax:856-779-7890
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2679
Practice Address - Country:US
Practice Address - Phone:856-779-9220
Practice Address - Fax:856-779-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-14
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02548900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080169223OtherRAILROAD MEDICARE
NJ2433109Medicaid
NJ080169223OtherRAILROAD MEDICARE
NJ2433109Medicaid