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NPI Code Detail

MEDICARE: STEPHANIE J. NACIM P.A.

MEDICARE: STEPHANIE J. NACIM P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant25MP00204100NJ

General Provider Information

NPI Number : 1568613925
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE J. NACIM P.A.
Provider Business Mailing Address
First Line : PO BOX 859
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-0859
Country : US
Telephone Number : 800-345-0064
Fax Number :
Provider Business Practice Location Address
First Line : 1544 KUSER RD STE C9
Second Line :
City : HAMILTON
State : NJ
Zip : 08619-3830
Country : US
Telephone Number : 734-329-5419
Fax Number : 855-716-4494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2008
Last Update Date : 01/18/2022

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