Provider Demographics
NPI:1902122724
Name:EVA BAMBERGER STAHL,MDPA
Entity Type:Organization
Organization Name:EVA BAMBERGER STAHL,MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:BAMBERGER
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-828-1001
Mailing Address - Street 1:31 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1731
Mailing Address - Country:US
Mailing Address - Phone:732-828-1001
Mailing Address - Fax:732-828-3314
Practice Address - Street 1:31 RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1731
Practice Address - Country:US
Practice Address - Phone:732-828-1001
Practice Address - Fax:732-828-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA01876000261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ459575Medicare PIN