Provider Demographics
NPI:1093897118
Name:NOTARISTEFANO, LUIGIA GINA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIGIA
Middle Name:GINA
Last Name:NOTARISTEFANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4026
Mailing Address - Country:US
Mailing Address - Phone:845-278-8797
Mailing Address - Fax:
Practice Address - Street 1:1591 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4026
Practice Address - Country:US
Practice Address - Phone:845-278-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
76U651Medicare PIN