Healthcare Provider Details

I. General information

NPI: 1952426785
Provider Name (Legal Business Name): PATRICK J STEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5627 MARTHAS VINEYARD
CLARENCE CENTER NY
14032-9001
US

IV. Provider business mailing address

5627 MARTHAS VINEYARD
CLARENCE CENTER NY
14032-9001
US

V. Phone/Fax

Practice location:
  • Phone: 716-491-7057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number208984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: