Healthcare Provider Details

I. General information

NPI: 1689770844
Provider Name (Legal Business Name): STEFAN H. FADERL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SECOND ST.
HACKENSACK NJ
07601
US

IV. Provider business mailing address

100 FIRST ST. SUITE 301
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3925
  • Fax: 551-996-0574
Mailing address:
  • Phone: 551-996-3925
  • Fax: 551-996-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberK7015
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA09307400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: