Provider Demographics
NPI:1528259264
Name:STEPHEN FALKOWSKI, DO PA
Entity type:Organization
Organization Name:STEPHEN FALKOWSKI, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:856-985-4600
Mailing Address - Street 1:12000 LINCOLN DR W
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3402
Mailing Address - Country:US
Mailing Address - Phone:856-985-4600
Mailing Address - Fax:856-985-9844
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:SUITE 309
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-985-4600
Practice Address - Fax:856-985-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03338900207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1425609Medicaid
NJ1425609Medicaid
NJ113796Medicare PIN