Basic Information
| Provider Information | |||||||||
| NPI: | 1447459292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAM | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 CRYSTAL RUN RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109417001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457036999 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | FLORHAM PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734049800 | ||||||||
| FaxNumber: | 9732671737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 245200 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 25MB09389800 | NJ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 03259056 | 05 | NY | MEDICAID |