Provider Demographics
NPI:1154956555
Name:MCNAMARA, STEPHEN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCNAMARA
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:PO BOX 1033
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-0004
Mailing Address - Country:US
Mailing Address - Phone:732-278-3216
Mailing Address - Fax:
Practice Address - Street 1:432 3RD ST
Practice Address - Street 2:
Practice Address - City:BEACH HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:08008-1809
Practice Address - Country:US
Practice Address - Phone:732-278-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01024400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily