Stephenson, Derek Allen

Stephenson, Derek Allen is an sole proprietor health care provider with primary practice located at 1103 West Sherman Avenue Building 2 Unit C, Vineland NJ 08360. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Stephenson, Derek Allen can be contacted via phone (856) 362-5259.

Contact Information

Primary practice address
1103 West Sherman Avenue Building 2 Unit C Vineland NJ 08360
Phone: (856) 362-5259
Fax: (856) 405-6978
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X R70529 Arizona
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X ME116873 Florida
Allopathic & Osteopathic Physicians / Surgery 208600000X 25MA09618900 New Jersey

Profile Details

NPI number 1740441443
LBN Legal business name Stephenson, Derek Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 24th, 2008
Last updated Dec 31st, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740441443 NPPES
New Jersey MEDICAID 0475025

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