Provider Demographics
NPI:1477637312
Name:STOFF, JESSE ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:ANDREW
Last Name:STOFF
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:PO BOX 640247
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-0247
Mailing Address - Country:US
Mailing Address - Phone:520-241-1944
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2855
Practice Address - Country:US
Practice Address - Phone:516-759-4200
Practice Address - Fax:516-759-7600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150159207K00000X
NY150519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA59835Medicare UPIN