Healthcare Provider Details

I. General information

NPI: 1972913986
Provider Name (Legal Business Name): STEVEN JOHN STOLTZENBERG P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W OAK ST.
KISSIMMEE FL
34741-4941
US

IV. Provider business mailing address

3012 FIELDCREST LANE
TOMS RIVER NJ
08755-2559
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-4000
  • Fax: 407-846-4808
Mailing address:
  • Phone: 732-804-8573
  • Fax: 718-981-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114681
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00399500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number017824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: