Healthcare Provider Details

I. General information

NPI: 1093026544
Provider Name (Legal Business Name): STEPHEN POSLUSZNY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67A MOUNTAIN BLVD EXT 1ST FLOOR UNIT B
WARREN NJ
07059
US

IV. Provider business mailing address

67A MOUNTAIN BLVD EXT 1ST FLOOR UNIT B
WARREN NJ
07059
US

V. Phone/Fax

Practice location:
  • Phone: 88-736-3379
  • Fax:
Mailing address:
  • Phone: 908-873-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10518400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: