Healthcare Provider Details

I. General information

NPI: 1699769760
Provider Name (Legal Business Name): JOHN R STAFFORD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST NORTHERN WESTCHESTER HOSPITAL 3RD FLOOR
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

400 E MAIN ST NORTHERN WESTCHESTER HOSPITAL 3RD FLOOR
MOUNT KISCO NY
10549-3417
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1272
  • Fax: 914-666-1002
Mailing address:
  • Phone: 914-666-1272
  • Fax: 914-666-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number173853
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: