=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336234780
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHLOMO M. STEMMER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 04/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 HADDON AVE. SUITE 207
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-428-6355
-----------------------------------------------------
Fax | 856-428-6388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 HADDON AVE. SUITE 207
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-428-6355
-----------------------------------------------------
Fax | 856-428-6388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA061125
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------