Provider Demographics
NPI:1407946288
Name:AMODIO, STEFANO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANO
Middle Name:
Last Name:AMODIO
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 1:2516 169TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1114
Mailing Address - Country:US
Mailing Address - Phone:718-428-5800
Mailing Address - Fax:718-428-5810
Practice Address - Street 1:2516 169TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1114
Practice Address - Country:US
Practice Address - Phone:718-428-5800
Practice Address - Fax:718-428-5810
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203734207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02281152Medicaid
NY02281152Medicaid
NY554ALBMedicare ID - Type UnspecifiedGHI MEDICARE