Healthcare Provider Details

I. General information

NPI: 1447457791
Provider Name (Legal Business Name): JOSEPH MICHAEL STINELLI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1189
US

IV. Provider business mailing address

140 E RIDGEWOOD AVE STE 720N
PARAMUS NJ
07652-3917
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax: 201-541-2188
Mailing address:
  • Phone: 201-447-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00112900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: