Stephen Charles Licetti, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB08833000 Issued in NJ

Practice address

34 Scotch Rd Ste 1
Ewing, NJ 08628-2528

Phone

(609) 498-7670

Fax

(609) 385-4150

NPI assigned

Jan 20, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Hunterdon Family Physicians Inc.

  • Family Medicine Physician
  • Flemington, NJ
  • NPI 1306875273
  Medicare reassignment NPD
• Rowansom Dept of Pediatrics

  • Pediatrics Physician
  • Sewell, NJ
  • NPI 1275503203
  NPD (past)
• Trihealth H LLC

  • Obstetrics Physician
  • Cincinnati, OH
  • NPI 1811215742
  NPD (past)

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1558508192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 YORKTOWN PLZ",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 SCOTCH RD STE 1",
            "city": "EWING",
            "state": "NJ",
            "postal_code": "086282528",
            "telephone_number": "609-498-7670",
            "fax_number": "609-385-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICETTI",
        "first_name": "STEPHEN",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-20",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB08833000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Lenobel
• Level Up
• Corenthia Lewis
• Lexington Avenue Chiropractic Center LLC
• Liberty Dental Plan Organization
• Life & Family Guidance
• Lifeties Inc.
• Lifeties, Inc Triad Special Needs
• Lifetouch Behavioral Health, LLC
• Lincare Inc

• Family Medicine Physician in Ewing, NJ
• Providers in Ewing, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.