Provider Demographics
NPI:1629800123
Name:RICHARDSON, STEPHAN (OWNER)
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:MRS
Other - First Name:DASHAWNIA
Other - Middle Name:
Other - Last Name:MAGAZINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OWNER
Mailing Address - Street 1:4 VERMELLA WAY APT 354
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-2654
Mailing Address - Country:US
Mailing Address - Phone:747-238-8620
Mailing Address - Fax:
Practice Address - Street 1:17 MEMORIAL DR STE 3
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1065
Practice Address - Country:US
Practice Address - Phone:856-220-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health