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General NPI Number Information
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NPI Number | 1508842261
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Entity Type | Individual
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Provider Name | STAFFORD D JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 3435 70TH ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-1055
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Country | US
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Telephone | 718-651-9700
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Fax | 718-533-0264
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Provider Business Mailing Address
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Address Line | 723 REMSEN AVE
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City | BROOKLYN
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State | NY
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Zip | 11236-1227
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Country | US
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Telephone | 718-345-9106
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Fax | 718-533-0264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 020469
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 020469
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License Number State | NY
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