Healthcare Provider Details

I. General information

NPI: 1619204666
Provider Name (Legal Business Name): AILEEN STAHL RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax: 732-249-0969
Mailing address:
  • Phone: 732-745-8600
  • Fax: 732-249-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number26NR02975700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: