Basic Information
| Provider Information | |||||||||
| NPI: | 1720080559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEST | ||||||||
| FirstName: | STUART | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 GROVE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567969200 | ||||||||
| FaxNumber: | 8567969397 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 SUNSET RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080163645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092981776 | ||||||||
| FaxNumber: | 6095312391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA05310200 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 25MA05310200 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2403307 | 05 | NJ | MEDICAID |