Provider Demographics
NPI:1477568186
Name:STEPHANE NAOUMOFF MD
Entity Type:Organization
Organization Name:STEPHANE NAOUMOFF MD
Other - Org Name:RIVERSIDE FAMILY HEALTH PL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAOUMOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-453-5252
Mailing Address - Street 1:1395 N COURTENAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4474
Mailing Address - Country:US
Mailing Address - Phone:321-453-5252
Mailing Address - Fax:321-453-5152
Practice Address - Street 1:1395 N COURTENAY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4474
Practice Address - Country:US
Practice Address - Phone:321-453-5252
Practice Address - Fax:321-453-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113538600Medicaid
FLK3255Medicare ID - Type Unspecified
FL262853800Medicaid