Healthcare Provider Details

I. General information

NPI: 1679526818
Provider Name (Legal Business Name): GEORGE R STEFANOS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 UNION HILL DR SUITE B
SPENCERPORT NY
14559-1965
US

IV. Provider business mailing address

21 UNION HILL DR SUITE B
SPENCERPORT NY
14559-1965
US

V. Phone/Fax

Practice location:
  • Phone: 585-352-3535
  • Fax: 585-352-6004
Mailing address:
  • Phone: 585-352-3535
  • Fax: 585-352-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number203442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: