Provider Demographics
NPI:1588600340
Name:SHROYER, STEPHEN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:SHROYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 1/2 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7010
Mailing Address - Country:US
Mailing Address - Phone:732-280-0660
Mailing Address - Fax:732-681-1264
Practice Address - Street 1:1420 1/2 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-7010
Practice Address - Country:US
Practice Address - Phone:732-280-0660
Practice Address - Fax:732-681-1264
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04074500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1524909-01Medicaid
NJ46445385DMedicaid
NJSH517414Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJD92587Medicare UPIN