Healthcare Provider Details

I. General information

NPI: 1033114475
Provider Name (Legal Business Name): STEFANO M STELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 UNION AVE SUITE 101
RUTHERFORD NJ
07070-1272
US

IV. Provider business mailing address

PO BOX 156
FRANKLIN LAKES NJ
07417-0156
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-4775
  • Fax: 201-935-0549
Mailing address:
  • Phone: 201-933-4775
  • Fax: 201-935-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04443100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: