Basic Information
| Provider Information | |||||||||
| NPI: | 1871750307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEFANIDES | ||||||||
| FirstName: | PARASKEVAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 MONTAUK HWY | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
| FaxNumber: | 6318938012 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 MONTAUK HWY | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314225371 | ||||||||
| FaxNumber: | 6318938012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 870515631 | UT | N | Hospitals | General Acute Care Hospital | 283X00000X | 870515631 | UT | N | Hospitals | Rehabilitation Hospital | 2081P2900X | 249030 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.