Provider Demographics
NPI:1285794255
Name:STUART D. SHOENGOLD, M.D., P.A.
Entity type:Organization
Organization Name:STUART D. SHOENGOLD, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHOENGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-218-9400
Mailing Address - Street 1:225 MILLBURN AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1737
Mailing Address - Country:US
Mailing Address - Phone:973-218-9400
Mailing Address - Fax:973-218-9420
Practice Address - Street 1:225 MILLBURN AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1737
Practice Address - Country:US
Practice Address - Phone:973-218-9400
Practice Address - Fax:973-218-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03340400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty