Healthcare Provider Details

I. General information

NPI: 1689870073
Provider Name (Legal Business Name): STEPHEN TAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 LIPPINCOTT DR STE F
MARLTON NJ
08053-4168
US

IV. Provider business mailing address

826 MAIN ST SUITE 201
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 856-435-9100
  • Fax: 856-435-9112
Mailing address:
  • Phone: 610-415-1100
  • Fax: 610-415-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD439559
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA09772700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: