Basic Information
| Provider Information | |||||||||
| NPI: | 1578863031 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 1272 STIRLING MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7240 | ||||||||
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| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334687240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617482889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1272 LONG HILL RD | ||||||||
| Address2: | |||||||||
| City: | STIRLING | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079801010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617482889 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2010 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | BARLOW | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING COMPANY | ||||||||
| AuthorizedOfficialTelephone: | 5617482889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PRESIDENT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 26NN11834600 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.