Provider Demographics
NPI:1881732667
Name:STEVEN POTTER, MD LLC
Entity type:Organization
Organization Name:STEVEN POTTER, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DARREN
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-839-7400
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-0367
Mailing Address - Country:US
Mailing Address - Phone:973-839-7400
Mailing Address - Fax:973-831-4911
Practice Address - Street 1:287 BOULEVARD
Practice Address - Street 2:SUITE #1
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1726
Practice Address - Country:US
Practice Address - Phone:973-839-7400
Practice Address - Fax:973-831-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ870907Medicare ID - Type Unspecified
NJG34060Medicare UPIN