Provider Demographics
NPI:1164846747
Name:FUNK, STEPHEN F (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:FUNK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 DAVID CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4415
Mailing Address - Country:US
Mailing Address - Phone:516-238-6125
Mailing Address - Fax:
Practice Address - Street 1:3037 DAVID CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4415
Practice Address - Country:US
Practice Address - Phone:516-238-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017362363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical