Individual
MR. JASON STABACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17644 COASTAL HWY #6, LEWES, DE 19958
(877) 425-7756
Mailing address
17644 COASTAL HWY #6, LEWES, DE 19958
(877) 425-7756
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
25MP00051300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0161662
GHI PPO
NJ
01
—
320525
AMERICAID/AMERIGROUP
NJ
01
—
3K5491
HEALTHNET
NJ
Enumeration date
05/11/2006
Last updated
04/10/2023
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