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NPI Code Detail

MEDICARE: STEPHEN M KILLIAN PA-C

MEDICARE: STEPHEN M KILLIAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMP00082200NJ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1172600OTHERNJMEDICARE PTAN

General Provider Information

NPI Number : 1841231826
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN M KILLIAN PA-C
Provider Business Mailing Address
First Line : 325 PRINCETON AVE
Second Line :
City : PRINCETON
State : NJ
Zip : 08540-1617
Country : US
Telephone Number : 609-924-8131
Fax Number : 609-924-8532
Provider Business Practice Location Address
First Line : 325 PRINCETON AVE
Second Line :
City : PRINCETON
State : NJ
Zip : 08540-1617
Country : US
Telephone Number : 609-924-8131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 10/02/2019

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Directions to “ STEPHEN M KILLIAN PA-C” Practice Location

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