Provider Demographics
NPI:1932397916
Name:STORCH, STEVEN MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:STORCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LAFAYETTE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3497
Mailing Address - Country:US
Mailing Address - Phone:973-300-1553
Mailing Address - Fax:973-383-6236
Practice Address - Street 1:540 LAFAYETTE RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3497
Practice Address - Country:US
Practice Address - Phone:973-300-1553
Practice Address - Fax:973-383-6236
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00203700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant