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General NPI Number Information
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NPI Number | 1568520708
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Entity Type | Individual
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Provider Name | STEPHEN GOLUB MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 118 NORTH COUNTRY ROAD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-473-7171
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Fax | 631-473-4605
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Provider Business Mailing Address
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Address Line | 118 NORTH COUNTRY ROAD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-473-7171
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Fax | 631-473-4605
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 142187
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 1421871
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License Number State | NY
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