Provider Demographics
NPI:1356442073
Name:MIGDEN, STEPHEN DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:MIGDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 C OLD COUNTRY RD #414
Mailing Address - Street 2:
Mailing Address - City:PLAIN VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-236-5016
Mailing Address - Fax:516-625-0824
Practice Address - Street 1:142 MINEOLA AVE
Practice Address - Street 2:2I
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-625-0824
Practice Address - Fax:516-625-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV16801Medicare ID - Type Unspecified