Healthcare Provider Details

I. General information

NPI: 1518491935
Provider Name (Legal Business Name): STEPHEN ANTHONY IACONO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S ORANGE AVE MEDICAL SCIENCE BUILDING, ROOM G 532
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

185 S ORANGE AVE MEDICAL SCIENCE BUILDING, ROOM G 532
NEWARK NJ
07103-2757
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5682
  • Fax: 973-972-7425
Mailing address:
  • Phone: 973-972-5682
  • Fax: 973-972-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0102960
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0102960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: