Healthcare Provider Details

I. General information

NPI: 1205842408
Provider Name (Legal Business Name): STEPHEN AMAEFUNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FAAS CT
WEST ORANGE NJ
07052-2652
US

IV. Provider business mailing address

4 FAAS CT
WEST ORANGE NJ
07052-2652
US

V. Phone/Fax

Practice location:
  • Phone: 973-715-2688
  • Fax: 973-324-9725
Mailing address:
  • Phone: 973-715-2688
  • Fax: 973-324-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA63115
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMA63115
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number25MA06311500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number063115
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: