Provider Demographics
NPI:1346677614
Name:CAGLIOSTRO, STEPHEN NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:NICHOLAS
Last Name:CAGLIOSTRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W 119TH ST
Mailing Address - Street 2:APT 9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7110
Mailing Address - Country:US
Mailing Address - Phone:914-539-0445
Mailing Address - Fax:
Practice Address - Street 1:1460 POST RD E
Practice Address - Street 2:#9
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5500
Practice Address - Country:US
Practice Address - Phone:203-853-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT115791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics