Provider Demographics
NPI:1174677363
Name:MAGIDSON, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:STEVEN
Last Name:MAGIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:S
Other - Last Name:MAGIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:28 WOODFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1112
Mailing Address - Country:US
Mailing Address - Phone:631-751-5941
Mailing Address - Fax:
Practice Address - Street 1:28 WOODFIELD ROAD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1112
Practice Address - Country:US
Practice Address - Phone:631-751-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080879207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01602570335OtherAMA MEDICAL EDUCATION #
AM3483093OtherDEA
B01803Medicare UPIN