Healthcare Provider Details

I. General information

NPI: 1760488373
Provider Name (Legal Business Name): STUART MICHAEL HOMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 201
AVENEL NJ
07001-1330
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 201
AVENEL NJ
07001-1330
US

V. Phone/Fax

Practice location:
  • Phone: 732-602-0244
  • Fax: 732-602-2577
Mailing address:
  • Phone: 732-602-0244
  • Fax: 732-602-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMA46118
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: