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NPI Code Detail

MEDICARE: MR. STAFFORD D JOHN MD

MEDICARE: MR. STAFFORD D JOHN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1173000000XLegal Medicine
2174400000XSpecialist020469NY
3207RN0300XNephrology Physician020469NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508842261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STAFFORD D JOHN MD
Provider Business Mailing Address
First Line : 723 REMSEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-1227
Country : US
Telephone Number : 718-345-9106
Fax Number : 718-533-0264
Provider Business Practice Location Address
First Line : 3435 70TH ST
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-1055
Country : US
Telephone Number : 718-651-9700
Fax Number : 718-533-0264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 12/05/2014

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