Provider Demographics
NPI:1215937354
Name:STANLEY, MICHAEL STEWART (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEWART
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-1221
Mailing Address - Country:US
Mailing Address - Phone:270-404-0340
Mailing Address - Fax:
Practice Address - Street 1:CAPE MAY USCG CLINIC
Practice Address - Street 2:1 MUNRO AVE
Practice Address - City:CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204
Practice Address - Country:US
Practice Address - Phone:609-898-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA581363A00000X
NJ25MP00701300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50073444OtherPASSPORT MANAGED MEDICAID
KY9500251500Medicaid
KY50073444OtherPASSPORT MANAGED MEDICAID