Provider Demographics
NPI:1093773350
Name:NURKIEWICZ, STEPHEN A (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:NURKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:858 S WHITE HORSE PIKE # B2
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2031
Mailing Address - Country:US
Mailing Address - Phone:609-561-2345
Mailing Address - Fax:833-450-6356
Practice Address - Street 1:858 S WHITE HORSE PIKE STE B2
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2031
Practice Address - Country:US
Practice Address - Phone:609-561-2345
Practice Address - Fax:833-450-6356
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05289300207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4564737OtherAETNA
NJ0360950001OtherAMERIHEALTH
NJP377258OtherOXFORD
NJ110029199OtherRAILROAD
NJJ5463OtherHORIZON
NJ110029199OtherRAILROAD
NJ4564737OtherAETNA
NJE22258Medicare UPIN