Individual
DR. STEPHEN CHARLES LICETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
34 SCOTCH RD STE 1, EWING, NJ 08628-2528
(609) 498-7670
(609) 385-4150
Mailing address
210 YORKTOWN PLZ, ELKINS PARK, PA 19027-1424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MB08833000
NJ
Other
Enumeration date
01/20/2009
Last updated
09/02/2020
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