Provider Demographics
NPI:1932190386
Name:LINDHOLM, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:LINDHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 W ESSEX ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1023
Mailing Address - Country:US
Mailing Address - Phone:201-226-0145
Mailing Address - Fax:201-226-0147
Practice Address - Street 1:113 W ESSEX ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1023
Practice Address - Country:US
Practice Address - Phone:201-226-0145
Practice Address - Fax:201-226-0147
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80180207X00000X
NJ25MA08253100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114431Medicare PIN