Provider Demographics
NPI:1306984737
Name:PIETROFESA, STEVEN (PA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:PIETROFESA
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2315 HIGHWAY 34 SOUTH
Mailing Address - Street 2:SUITE D
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1423
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-449-4271
Practice Address - Street 1:2315 HIGHWAY 34 SOUTH
Practice Address - Street 2:SUITE D
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1423
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-449-4271
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ000742363AS0400X
NY006514363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00936761OtherRR MEDICARE
NJ174053ZF1BMedicare PIN
P00936761OtherRR MEDICARE
Q28358Medicare UPIN