Provider Demographics
NPI:1053337253
Name:CHOI, STANLEY S (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:CHOI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STAN
Other - Middle Name:S
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2177 OAK TREE RD
Mailing Address - Street 2:STE 209
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1082
Mailing Address - Country:US
Mailing Address - Phone:908-769-1020
Mailing Address - Fax:908-668-1486
Practice Address - Street 1:2177 OAK TREE RD
Practice Address - Street 2:STE 209
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1082
Practice Address - Country:US
Practice Address - Phone:908-769-1020
Practice Address - Fax:908-668-1486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03122200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1391607Medicaid
NJ1391607Medicaid
451570Medicare ID - Type Unspecified