Provider Demographics
NPI:1508801481
Name:STEFANIDES, ANGELO ANASTASSIOS (PT)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANASTASSIOS
Last Name:STEFANIDES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JOCELYN PL
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1233
Mailing Address - Country:US
Mailing Address - Phone:973-768-7247
Mailing Address - Fax:973-513-9056
Practice Address - Street 1:1082 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5604
Practice Address - Country:US
Practice Address - Phone:973-768-7247
Practice Address - Fax:239-263-7965
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT358542251X0800X
NJ40QA00884800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist