Healthcare Provider Details

I. General information

NPI: 1740251495
Provider Name (Legal Business Name): STEPHEN THOMAS SPATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 POMPTON AVE
VERONA NJ
07044
US

IV. Provider business mailing address

347 MOUNT PLEASANT AVE SUITE 205
WEST ORANGE NJ
07052-2744
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-2121
  • Fax: 973-571-2126
Mailing address:
  • Phone: 973-571-2121
  • Fax: 973-571-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMA07427500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: