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General NPI Number Information
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NPI Number | 1457161614
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Entity Type | Organization
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Legal Business Name | STEPHEN MEDICAL, PLLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 18507 64TH AVE BSMT MEDICAL
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2707
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Country | US
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Telephone | 347-368-6222
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Fax | 347-368-6291
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Provider Business Mailing Address
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Address Line | 18507 64TH AVE BSMT MEDICAL
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2707
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Country | US
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Telephone | 347-368-6222
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Fax | 347-368-6291
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK STEPHEN
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Credential | DO
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Telephone | 347-368-6222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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