Healthcare Provider Details

I. General information

NPI: 1396705976
Provider Name (Legal Business Name): STEVEN T DINSMORE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LAUREL RD E UDP #1800
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

PO BOX 635
BELLMAWR NJ
08099-0635
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6843
  • Fax: 856-566-6419
Mailing address:
  • Phone: 856-770-5772
  • Fax: 856-566-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMB04322400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: