Healthcare Provider Details

I. General information

NPI: 1649858986
Provider Name (Legal Business Name): MARY E STUCKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

1 ROBERT WOOD JOHNSON PLACE MEDICAL EDUCATION BUILDING ROOM 388A
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2232
  • Fax:
Mailing address:
  • Phone: 201-951-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA12166600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: