Healthcare Provider Details

I. General information

NPI: 1093581902
Provider Name (Legal Business Name): STEM-REGEN MEDICAL WELLNESS & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 N RTE 17 STE 150
PARAMUS NJ
07652-2742
US

IV. Provider business mailing address

PO BOX 234696
GREAT NECK NY
11023-4696
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-2222
  • Fax: 201-368-2223
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. STEVEN MOALEMI
Title or Position: PRESIDENT
Credential: MD
Phone: 201-368-2222