Healthcare Provider Details

I. General information

NPI: 1780672410
Provider Name (Legal Business Name): STAVROS THOMAS SNYDER M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

97 NEW DORP LN
STATEN ISLAND NY
10306-2359
US

V. Phone/Fax

Practice location:
  • Phone: 718-683-3955
  • Fax: 718-683-3744
Mailing address:
  • Phone: 718-876-6220
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number150801-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: