Healthcare Provider Details

I. General information

NPI: 1598917825
Provider Name (Legal Business Name): NEOFITOS STEFANIDES M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 FRANCIS LEWIS BLVD SUITE L3B
BAYSIDE NY
11361-3002
US

IV. Provider business mailing address

100 BROMPTON RD
GARDEN CITY NY
11530-2704
US

V. Phone/Fax

Practice location:
  • Phone: 718-989-8515
  • Fax: 718-989-6825
Mailing address:
  • Phone: 718-989-8515
  • Fax: 718-989-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number240488-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number240488-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number240488-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number240488-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number240488-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number240488-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number240488-1
License Number StateNY

VIII. Authorized Official

Name: DR. NEOFITOS STEFANIDES
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-989-8515