Healthcare Provider Details

I. General information

NPI: 1528259264
Provider Name (Legal Business Name): STEPHEN FALKOWSKI, DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 LINCOLN DR W SUITE 309
MARLTON NJ
08053-3402
US

IV. Provider business mailing address

12000 LINCOLN DR W SUITE 309
MARLTON NJ
08053-3402
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-4600
  • Fax: 856-985-9844
Mailing address:
  • Phone: 856-985-4600
  • Fax: 856-985-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB03338900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MB03338900
License Number StateNJ

VIII. Authorized Official

Name: WYNNE FALKOWSKI
Title or Position: OFFICER/PRACTICE ADMINISTRATOR
Credential: RN
Phone: 856-985-4600