Healthcare Provider Details

I. General information

NPI: 1508671975
Provider Name (Legal Business Name): STEPHANIE BARON AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 NORTHFIELD AVE STE 205
WEST ORANGE NJ
07052-1104
US

IV. Provider business mailing address

53 LONGVIEW AVE
RANDOLPH NJ
07869-3008
US

V. Phone/Fax

Practice location:
  • Phone: 215-895-2000
  • Fax:
Mailing address:
  • Phone: 201-572-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ15228600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: