Provider Demographics
NPI:1972913986
Name:STOLTZENBERG, STEVEN JOHN (PA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:STOLTZENBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3012 FIELDCREST LANE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2559
Mailing Address - Country:US
Mailing Address - Phone:732-804-8573
Mailing Address - Fax:718-981-1856
Practice Address - Street 1:903 W OAK ST.
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4941
Practice Address - Country:US
Practice Address - Phone:407-846-4000
Practice Address - Fax:407-846-4808
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017824363AM0700X
FLPA9114681363A00000X
NJ25MP00399500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical