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General NPI Number Information
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NPI Number | 1659648483
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Entity Type | Organization
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Legal Business Name | STEPHEN R. HILLER, MD, PC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 5360 NESCONSET HWY STE. D
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2018
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Country | US
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Telephone | 631-928-7070
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Fax | 631-928-0093
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Provider Business Mailing Address
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Address Line | 5360 NESCONSET HWY STE. D
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2018
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Country | US
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Telephone | 631-928-7070
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Fax | 631-928-0093
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN R. HILLER
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Credential | MD
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Telephone | 631-928-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 112016
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License Number State | NY
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