Provider Demographics
NPI:1053580712
Name:MACIEJEWSKI, STEPHEN JOHN (PT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:MACIEJEWSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHADOW HILL WAY
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5672
Mailing Address - Country:US
Mailing Address - Phone:908-979-1115
Mailing Address - Fax:
Practice Address - Street 1:385 STATE ROUTE 24 STE 3G
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2910
Practice Address - Country:US
Practice Address - Phone:908-879-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00735100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist