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Individual

CHARLES M. STIVALA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
65 W JIMMIE LEEDS RD, POMONA, NJ 08240-9102
(609) 748-7089
(609) 652-3460
Mailing address
3600 ROUTE 66 FL 3, NEPTUNE, NJ 07753-2645
(732) 807-0880

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
OS012844
PA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
25MB10453400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0666726
NJ
05
100816858
PA
Enumeration date
09/23/2005
Last updated
12/19/2023
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