Nicholas Stafford, CPRS

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1000140 Issued in NJ

Practice address

610 Pemberton Browns Mills Rd
Pemberton, NJ 08068-1537

Phone

(609) 321-6269

Fax

(609) 283-0262

NPI assigned

Nov 10, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1700594488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 PEMBERTON BROWNS MILLS RD",
            "city": "PEMBERTON",
            "state": "NJ",
            "postal_code": "080681537",
            "telephone_number": "609-321-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PEMBERTON BROWNS MILLS RD",
            "city": "PEMBERTON",
            "state": "NJ",
            "postal_code": "080681537",
            "telephone_number": "609-321-6269",
            "fax_number": "609-283-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "NICHOLAS",
        "credential": "CPRS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NJ",
            "license": "1000140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE ABUSE REHABILITATION FACILITY",
            "identifier": "1000140",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nstafford@maryvillenj.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "610 Pemberton Browns Mills Rd",
            "city": "Pemberton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080681537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Pemberton, NJ
• Providers in Pemberton, NJ by specialty
• Substance Abuse Rehabilitation Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2022; 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.