Healthcare Provider Details

I. General information

NPI: 1821837337
Provider Name (Legal Business Name): STATIONMD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 VALLEY ST STE 203
MAPLEWOOD NJ
07040-4300
US

IV. Provider business mailing address

515 VALLEY ST STE 203
MAPLEWOOD NJ
07040-4300
US

V. Phone/Fax

Practice location:
  • Phone: 908-663-2929
  • Fax:
Mailing address:
  • Phone: 908-663-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TURNER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 908-663-2929