Provider Demographics
NPI:1114947207
Name:ODDO, STEPHEN MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARIO
Last Name:ODDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:340 W 19TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3985
Mailing Address - Country:US
Mailing Address - Phone:917-406-3861
Mailing Address - Fax:718-763-0522
Practice Address - Street 1:914 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2302
Practice Address - Country:US
Practice Address - Phone:718-748-5700
Practice Address - Fax:718-763-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY195022207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01722283Medicaid
NY70T471Medicare PIN
NYF80533Medicare UPIN
NY01722283Medicaid