MEDICARE: STEFANIE M PARKER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	022842	NY
2	363AM0700X	Medical Physician Assistant	022842	NY

General Provider Information

NPI Number	:	1689104655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE M PARKER PA

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3143 BROADWAY APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4107
Country	:	US
Telephone Number	:	912-398-8777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	02/02/2019

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Directions to “ STEFANIE M PARKER PA” Practice Location

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