Individual provider Active NPI

Stuart Richard Solomon, DO

  • Emergency Medicine Physician
  • Marlton, NJ
National Provider Identifier
1467492744
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MB33467 Issued in NJ
Practice address
90 Brick Rd
Marlton, NJ 08053-2177
Phone
(856) 355-6760
Fax
(856) 355-6061
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MB33467 NJ Primary

Addresses

Primary practice location

90 Brick Rd
Marlton, NJ 08053-2177

Mailing address

307 S Evergreen Ave
Woodbury, NJ 08096-2739
Phone (856) 686-4300

Other identifiers 1

IdentifierTypeStateIssuer
2523205MedicaidNJ

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
I20031125000074 NJ Practitioner - Emergency MedicinePractitioner - General Practice 8628972262 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MB33467NJMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Associates of South Jersey P C Emergency Medicine CurrentSince Apr 1, 1998 Accepting new patients

Locations

100 Townsend Ave
Berlin, NJ 08009
Phone (856) 322-3000

90 Brick Rd
Marlton, NJ 08053
Phone (856) 355-6040

101 Carnie Blvd
Voorhees, NJ 08043
Phone (856) 325-3000

307 S Evergreen Ave
Woodbury, NJ 08096
Phone (856) 686-4300

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1467492744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S EVERGREEN AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962739",
            "telephone_number": "856-686-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 BRICK RD",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532177",
            "telephone_number": "856-355-6760",
            "fax_number": "856-355-6061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "STUART",
        "middle_name": "RICHARD",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "MB33467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2523205",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.