Provider Demographics
NPI:1043298581
Name:HORNYAK, STEPHEN W (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:HORNYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3623
Mailing Address - Country:US
Mailing Address - Phone:718-442-3400
Mailing Address - Fax:718-720-4989
Practice Address - Street 1:1130 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3623
Practice Address - Country:US
Practice Address - Phone:718-442-3400
Practice Address - Fax:718-720-4989
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00439932Medicaid
NYB11342Medicare UPIN
NY00439932Medicaid