Healthcare Provider Details

I. General information

NPI: 1780611574
Provider Name (Legal Business Name): STEPHEN BIGELSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOUNT PLEASANT AVE SUITE C
DOVER NJ
07801-1629
US

IV. Provider business mailing address

57 MELROSE RD
MOUNTAIN LAKES NJ
07046-1009
US

V. Phone/Fax

Practice location:
  • Phone: 973-989-0500
  • Fax: 973-989-5046
Mailing address:
  • Phone: 973-331-8040
  • Fax: 973-989-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMA54672
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: