Healthcare Provider Details

I. General information

NPI: 1063649051
Provider Name (Legal Business Name): RUTH DEBORAH STEPHENSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST SUITE 4200
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

125 PATERSON ST SUITE 4200
NEW BRUNSWICK NJ
08901-1962
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6600
  • Fax:
Mailing address:
  • Phone: 732-235-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MB09683200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MB09683200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: