Healthcare Provider Details

I. General information

NPI: 1568613925
Provider Name (Legal Business Name): STEPHANIE J. NACIM P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE J. MILLER

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 KUSER RD STE C9
HAMILTON NJ
08619-3830
US

IV. Provider business mailing address

PO BOX 859
LIVINGSTON NJ
07039-0859
US

V. Phone/Fax

Practice location:
  • Phone: 734-329-5419
  • Fax: 855-716-4494
Mailing address:
  • Phone: 800-345-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00204100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: