Provider Demographics
NPI:1407119332
Name:VARTELAS DIMAGGIO, STEPHANIE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:VARTELAS DIMAGGIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1530
Mailing Address - Country:US
Mailing Address - Phone:516-859-6260
Mailing Address - Fax:
Practice Address - Street 1:71 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1530
Practice Address - Country:US
Practice Address - Phone:516-859-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist