NPIMap

Organization Active NPI

Stafford Medical PA

  • Non-Pharmacy Dispensing Site
  • Manahawkin, NJ
National Provider Identifier
1093052102
Registry record updated Jan 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA066536 Issued in NJ
Legal business name
STAFFORD MEDICAL PA
Practice address
1364 Route 72 W
2
Manahawkin, NJ 08050-2485
Phone
(609) 597-3416
NPI assigned
Jan 9, 2013
Organization subpart
Yes
Parent organization
MEDVANTX INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP Ops
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA066536 NJ Primary

Addresses

Primary practice location

1364 Route 72 W
2
Manahawkin, NJ 08050-2485

Mailing address

5626 Oberlin Dr
110
San Diego, CA 92121-1705

National Provider Directory

National Provider Directory
Tax ID family
Stafford Medical PA2 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1093052102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 ROUTE 72 W",
            "address_2": "2",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502485",
            "telephone_number": "609-597-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAFFORD MEDICAL PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX INC",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA066536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manahawkin, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.