Provider Demographics
NPI:1285751479
Name:STONERIDGE FAMILY MEDICINE
Entity type:Organization
Organization Name:STONERIDGE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-866-3200
Mailing Address - Street 1:440 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-2239
Mailing Address - Country:US
Mailing Address - Phone:717-866-3200
Mailing Address - Fax:717-866-3418
Practice Address - Street 1:7 W PARK AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1340
Practice Address - Country:US
Practice Address - Phone:717-866-3395
Practice Address - Fax:717-866-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty