Healthcare Provider Details

I. General information

NPI: 1962726760
Provider Name (Legal Business Name): STEFAN JOHN MLOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 BLOOMINGDALE RD FL 2
WHITE PLAINS NY
10605-1513
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3888
  • Fax: 914-949-1271
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number283826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: