Healthcare Provider Details

I. General information

NPI: 1073708236
Provider Name (Legal Business Name): FRANK J. STAFFORD I APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CHAPEL AVE W CHERRY HILL
CHERRY HILL NJ
08002-2051
US

IV. Provider business mailing address

2250 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2051
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-9000
  • Fax: 856-482-1159
Mailing address:
  • Phone: 856-482-9000
  • Fax: 856-482-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00129900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: