Healthcare Provider Details

I. General information

NPI: 1114924669
Provider Name (Legal Business Name): JEFFREY E STIRLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WILLIAMSON ST TRINITAS REGIONAL MEDICAL CENTER
ELIZABETH NJ
07202-3625
US

IV. Provider business mailing address

579 A CRANBURY RD
EAST BRUNSWICK NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-0040
  • Fax: 732-390-1856
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-390-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA05724700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA05724700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: