Individual provider Active NPI

Stephen B Gloria, D.O.

  • Family Medicine Physician
  • Oak Ridge, NJ
National Provider Identifier
1407825920
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MB04263000 Issued in NJ
Practice address
5678 Berkshire Valley Rd
Oak Ridge, NJ 07438-9370
Phone
(973) 697-0200
Fax
(973) 697-6844
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MB04263000 NJ Primary

Addresses

Primary practice location

5678 Berkshire Valley Rd
Oak Ridge, NJ 07438-9370

Mailing address

404 Lippincott Dr
Marlton, NJ 08053-4112
Phone (856) 782-3300

Other identifiers 1

IdentifierTypeStateIssuer
1920502MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100223000402 NJ Practitioner - Family Practice 5294775607

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
MB04263000NJMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1407825920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 LIPPINCOTT DR",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534112",
            "telephone_number": "856-782-3300",
            "fax_number": "856-504-8029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5678 BERKSHIRE VALLEY RD",
            "city": "OAK RIDGE",
            "state": "NJ",
            "postal_code": "074389370",
            "telephone_number": "973-697-0200",
            "fax_number": "973-697-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLORIA",
        "first_name": "STEPHEN",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB04263000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1920502",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Ridge, NJ

Sources for this page

Verify at the official NPI Registry.