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General NPI Number Information
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NPI Number | 1699098251
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Entity Type | Individual
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Provider Name | FREDERICK STANSBURY D.O,
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Gender | Male
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 16 POCONO RD SUITE 313
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City | DENVILLE
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State | NJ
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Zip | 07834-2901
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Country | US
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Telephone | 973-625-0112
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Fax |
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Provider Business Mailing Address
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Address Line | 16 POCONO RD STE 311
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City | DENVILLE
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State | NJ
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Zip | 07834-2908
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Country | US
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Telephone | 973-722-6960
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Fax | 888-685-8803
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25 MB05536000
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License Number State | NJ
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