Healthcare Provider Details

I. General information

NPI: 1508847880
Provider Name (Legal Business Name): RALPH E STOLZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 N CEDAR CREST BLVD SUITE 609
ALLENTOWN PA
18104-2351
US

IV. Provider business mailing address

10 BRASS CASTLE RD
WASHINGTON NJ
07882-6309
US

V. Phone/Fax

Practice location:
  • Phone: 610-433-7717
  • Fax: 610-433-5660
Mailing address:
  • Phone: 908-835-1910
  • Fax: 908-835-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS000711L
License Number StatePA

VIII. Authorized Official

Name: DR. RALPH STOLZ
Title or Position: PRESIDENT
Credential: DO
Phone: 610-433-7717