MEDICARE: DR. STEFAN GINGOLD KANTROWITZ M.D.

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
1	207RA0401X	Addiction Medicine (Internal Medicine) Physician	260273	NY

General Provider Information

NPI Number	:	1518296078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN GINGOLD KANTROWITZ M.D.

Provider Business Mailing Address
First Line	:	111 7TH ST UNIT 111
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5709
Country	:	US
Telephone Number	:	212-203-9744
Fax Number	:	408-413-1063

Provider Business Practice Location Address
First Line	:	111 7TH ST UNIT 111
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5709
Country	:	US
Telephone Number	:	212-203-9744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2009
Last Update Date	:	12/06/2022

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