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General NPI Number Information
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NPI Number | 1649640541
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Entity Type | Individual
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Provider Name | STEPHANIE SEUNGYEON OH PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2015
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1 CAPITAL WAY
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City | PENNINGTON
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State | NJ
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Zip | 08534-2520
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Country | US
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Telephone | 609-303-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST 3 SILVERSTEIN
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4238
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Country | US
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Telephone | 215-662-3487
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Fax | 215-349-5534
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00387800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MA057900
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License Number State | PA
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