Basic Information
| Provider Information | |||||||||
| NPI: | 1588734784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 W 82ND ST | ||||||||
| Address2: | 1-B | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100245352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | 7184058050 | ||||||||
| Practice Location | |||||||||
| Address1: | PEDS ACADEMIC ASSOC AT CFCC | ||||||||
| Address2: | 1621 EASTCHESTER ROAD | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | 7184058091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 153772 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.