Active NPI
Stephanie Carmen Custodio
- Licensed Practical Nurse
- Bridgeton, NJ
National Provider Identifier
1881385797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 26NP04816700
- Practice address
- 25 E Broad St
Bridgeton, NJ 08302-2503 - Phone
- (856) 459-2402
- NPI assigned
- May 19, 2023
- Last updated
- May 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 26NP04816700 | NJ | Primary |
Addresses
Primary practice location
25 E Broad St
Bridgeton, NJ 08302-2503
Mailing address
1026 Falcon Way
Vineland, NJ 08360-4469
Phone (609) 805-6509
Other practice location 1
9 Landis Ave
Bridgeton, NJ 08302-4315
Phone (856) 451-4169
Other names 1
- Stephanie Carmen Velez
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NP04816700 | NJ | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co. | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684454400000",
"number": "1881385797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 FALCON WAY",
"city": "VINELAND",
"state": "NJ",
"postal_code": "083604469",
"telephone_number": "609-805-6509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 E BROAD ST",
"city": "BRIDGETON",
"state": "NJ",
"postal_code": "083022503",
"telephone_number": "856-459-2402"
}
],
"practiceLocations": [
{
"address_1": "9 Landis Ave",
"address_purpose": "LOCATION",
"city": "Bridgeton",
"state": "NJ",
"postal_code": "083024315",
"country_code": "US",
"telephone_number": "856-451-4169",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CUSTODIO",
"first_name": "STEPHANIE",
"middle_name": "CARMEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-19",
"last_updated": "2023-05-19",
"certification_date": "2023-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NJ",
"license": "26NP04816700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "VELEZ",
"middle_name": "CARMEN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Bridgeton, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.