Healthcare Provider Details

I. General information

NPI: 1528042777
Provider Name (Legal Business Name): STEPHEN J SKOKAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 ROUTE 72 W
MANAHAWKIN NJ
08050-2485
US

IV. Provider business mailing address

1364 ROUTE 72 W
MANAHAWKIN NJ
08050-2485
US

V. Phone/Fax

Practice location:
  • Phone: 609-597-3416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00229400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: