Healthcare Provider Details

I. General information

NPI: 1710356241
Provider Name (Legal Business Name): DAVID STEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 WOODBURY RD
PLAINVIEW NY
11803-1008
US

IV. Provider business mailing address

543 WOODBURY RD
PLAINVIEW NY
11803-1008
US

V. Phone/Fax

Practice location:
  • Phone: 516-526-3634
  • Fax:
Mailing address:
  • Phone: 516-526-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number971444151
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: