Healthcare Provider Details

I. General information

NPI: 1861894982
Provider Name (Legal Business Name): SAINT PETER'S SPECIALTY PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RIVER AVE STE 110
LAKEWOOD NJ
08701-4738
US

IV. Provider business mailing address

254 EASTON AVENUE ATTN: MANAGED CARE DEPARTMENT
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 732-339-7880
  • Fax:
Mailing address:
  • Phone: 732-565-5453
  • Fax: 732-249-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: STACEY KNOWLES
Title or Position: DIRECTOR
Credential:
Phone: 732-565-5453