Provider Demographics
NPI:1497740815
Name:MENITOVE, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:MENITOVE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3952
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-5668
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-15
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Provider Licenses
StateLicense IDTaxonomies
NY1347601207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020680OtherGHI HMO
132995699OtherFAM HEALTH PLUS
132995699OtherHUDSON HEALTH PLAN MCD
132995699OtherCIGNA HMO POS
NY00707906Medicaid
0D0736OtherHEALTHNET OF THE NORTHEAS
123214OtherAETNA USHC
132995699OtherHORIZON HEALTHCARE OF NY
132995699OtherINDECS ORANGE ULSTER SCHL
358401OtherBCBS EMPIRE
132995699OtherCIGNA PPO
132995699OtherFEDELIS MEDICAID HMO
132995699OtherLOCAL 1199
132995699OtherBEECH STREET NETWORK
132995699OtherHEATLH NOW
2900091OtherGHI ALL PLANS EXCEPT HMO
4229785OtherAETNA
0X139POtherHIP
132995699OtherLOCAL 1199
2900091OtherGHI ALL PLANS EXCEPT HMO