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Individual

STANLEY JOHN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
324 W CLINTON AVE, BERGENFIELD, NJ 07621-1903
(917) 287-4154
Mailing address
324 W CLINTON AVE, BERGENFIELD, NJ 07621-1903
(917) 287-4154

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
015558
NY
363A00000X
Physician Assistant
25MP00395900
NJ

Other

Enumeration date
04/19/2012
Last updated
11/27/2016
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