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General NPI Number Information
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NPI Number | 1639409717
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Entity Type | Organization
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Legal Business Name | MARK E. STEPHEN MD P.C.
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 2 MARTINGALE GATE
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City | SAINT JAMES
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State | NY
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Zip | 11780-3546
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Country | US
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Telephone | 631-656-9517
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Fax |
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Provider Business Mailing Address
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Address Line | 2 MARTINGALE GATE
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City | SAINT JAMES
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State | NY
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Zip | 11780-3546
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Country | US
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Telephone | 631-656-9517
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARK STEPHEN
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Credential |
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Telephone | 631-656-9517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 213491
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License Number State | NY
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