Healthcare Provider Details

I. General information

NPI: 1588600340
Provider Name (Legal Business Name): STEPHEN JOHN SHROYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 1/2 SCHOOLHOUSE RD
WALL TOWNSHIP NJ
07753-7010
US

IV. Provider business mailing address

1420 1/2 SCHOOLHOUSE RD
WALL TOWNSHIP NJ
07753-7010
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-0660
  • Fax: 732-681-1264
Mailing address:
  • Phone: 732-280-0660
  • Fax: 732-681-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA04074500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: