Provider Demographics
NPI:1326131954
Name:STEVENS, ELIJAH BERNARD (ANP, NPP)
Entity Type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:BERNARD
Last Name:STEVENS
Suffix:
Gender:M
Credentials:ANP, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13089-2153
Mailing Address - Country:US
Mailing Address - Phone:315-663-4800
Mailing Address - Fax:
Practice Address - Street 1:305 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2524
Practice Address - Country:US
Practice Address - Phone:315-663-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4018441363LP0808X
NYF3028621363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF3028621OtherNP LICENCE NUMBER
NYF4018441OtherNP LICENCE NUMBER
NYF4018441OtherNP LICENCE NUMBER