Provider Demographics
NPI:1205864683
Name:DIGIOVANNI, STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:DIGIOVANNI
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 1:954 LEXINGTON AVE
Mailing Address - Street 2:295
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5055
Mailing Address - Country:US
Mailing Address - Phone:917-548-8975
Mailing Address - Fax:212-724-5036
Practice Address - Street 1:202 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5405
Practice Address - Country:US
Practice Address - Phone:917-548-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22-2469065OtherTAX ID#
NY22-2469065OtherTAX ID#