Provider Demographics
NPI:1124288154
Name:STEPHEN A. CHAGARES, MD, PC
Entity type:Organization
Organization Name:STEPHEN A. CHAGARES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CHAGARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-450-9700
Mailing Address - Street 1:1 EXECUTIVE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4933
Mailing Address - Country:US
Mailing Address - Phone:732-450-9700
Mailing Address - Fax:732-450-1511
Practice Address - Street 1:1 EXECUTIVE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4933
Practice Address - Country:US
Practice Address - Phone:732-450-9700
Practice Address - Fax:732-450-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63076208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126053Medicare PIN