Healthcare Provider Details

I. General information

NPI: 1811022288
Provider Name (Legal Business Name): STEPHEN WAYNE THAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KUSER ROAD
HAMILTON NJ
08691
US

IV. Provider business mailing address

3625 QUAKERBRIDGE RD
HAMILTON NJ
08619
US

V. Phone/Fax

Practice location:
  • Phone: 609-585-8800
  • Fax:
Mailing address:
  • Phone: 609-689-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberOS003172L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS 003172L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: