Provider Demographics
NPI:1932244910
Name:STEIN, ROGER (PA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:176 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1830
Mailing Address - Country:US
Mailing Address - Phone:973-699-4444
Mailing Address - Fax:973-877-2621
Practice Address - Street 1:433 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2520
Practice Address - Country:US
Practice Address - Phone:973-759-9000
Practice Address - Fax:973-751-3730
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00134400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant