Healthcare Provider Details

I. General information

NPI: 1396742086
Provider Name (Legal Business Name): STEVEN A MAFFEI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NAMI LN STE 1
MERCERVILLE NJ
08619-1251
US

IV. Provider business mailing address

1 NAMI LN STE 1
MERCERVILLE NJ
08619-1251
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-4100
  • Fax: 609-587-3278
Mailing address:
  • Phone: 609-587-4100
  • Fax: 609-587-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD00155700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: