Healthcare Provider Details

I. General information

NPI: 1083171243
Provider Name (Legal Business Name): STEPHANIE ROSE HOPKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

367 CHELSEA ST
STATEN ISLAND NY
10307-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5800
  • Fax:
Mailing address:
  • Phone: 646-591-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342775-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: