MEDICARE: STEPHANIE EWANCIW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639979222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE EWANCIW

Provider Business Mailing Address
First Line	:	1462 US HIGHWAY 6
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-3473
Country	:	US
Telephone Number	:	845-517-8026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1462 US HIGHWAY 6
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-3473
Country	:	US
Telephone Number	:	845-517-8026
Fax Number	:

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

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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Directions to “ STEPHANIE EWANCIW ” Practice Location

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