MEDICARE: DR. GARY F STEFANICK D.C.

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	111NR0400X	Rehabilitation Chiropractor	X3773	NY

General Provider Information

NPI Number	:	1699848739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY F STEFANICK D.C.

Provider Business Mailing Address
First Line	:	49 W 12TH ST
Second Line	:	1E
City	:	NEW YORK
State	:	NY
Zip	:	10011-8562
Country	:	US
Telephone Number	:	212-243-3080
Fax Number	:	212-243-0706

Provider Business Practice Location Address
First Line	:	49 W 12TH ST
Second Line	:	1E
City	:	NEW YORK
State	:	NY
Zip	:	10011-8562
Country	:	US
Telephone Number	:	212-243-3080
Fax Number	:	212-243-0706

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	07/08/2007

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