Healthcare Provider Details

I. General information

NPI: 1255785556
Provider Name (Legal Business Name): STEPHEN MASSIMI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACHLEY RD
STAMFORD CT
06902-0002
US

IV. Provider business mailing address

PO BOX 626
GREAT RIVER NY
11739-0626
US

V. Phone/Fax

Practice location:
  • Phone: 203-705-2350
  • Fax: 203-705-2924
Mailing address:
  • Phone: 203-705-2350
  • Fax: 203-705-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number255564
License Number StateNY

VIII. Authorized Official

Name: DR. STEPHEN JOSEPH MASSIMI
Title or Position: MEDICAL DOCTOR / BUSINESS OWNER
Credential: M.D.
Phone: 203-705-2350