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General NPI Number Information
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NPI Number | 1508057969
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Entity Type | Individual
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Provider Name | STEPHANE ROY D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 529 ROUTE 515 STE 102
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City | VERNON
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State | NJ
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Zip | 07462
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Country | US
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Telephone | 973-764-1513
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Fax |
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Provider Business Mailing Address
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Address Line | 314 MOUNTAIN RD
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City | CORNWALL ON HUDSON
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State | NY
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Zip | 12520-1806
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Country | US
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Telephone | 973-764-1513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38MC00624300
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License Number State | NJ
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