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General NPI Number Information
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NPI Number | 1518296078
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Entity Type | Individual
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Provider Name | STEFAN GINGOLD KANTROWITZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2009
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 111 7TH ST UNIT 111
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City | GARDEN CITY
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State | NY
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Zip | 11530-5709
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Country | US
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Telephone | 212-203-9744
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Fax |
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Provider Business Mailing Address
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Address Line | 111 7TH ST UNIT 111
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City | GARDEN CITY
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State | NY
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Zip | 11530-5709
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Country | US
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Telephone | 212-203-9744
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Fax | 408-413-1063
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 260273
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License Number State | NY
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