Provider Demographics
NPI:1902500697
Name:STEPHENS, JAMAL STEPHON
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:STEPHON
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 BERGENLINE AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5522
Mailing Address - Country:US
Mailing Address - Phone:609-579-5592
Mailing Address - Fax:
Practice Address - Street 1:5016 BERGENLINE AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5522
Practice Address - Country:US
Practice Address - Phone:609-579-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty