Healthcare Provider Details

I. General information

NPI: 1073439626
Provider Name (Legal Business Name): MARY-JOE STEPHAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HWY 36
WEST LONG BRANCH NJ
07764-1339
US

IV. Provider business mailing address

7 MARTINO DR
SOMERSET NJ
08873-4952
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-4534
  • Fax:
Mailing address:
  • Phone: 908-421-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: