Provider Demographics
NPI:1518296078
Name:KANTROWITZ, STEFAN GINGOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:GINGOLD
Last Name:KANTROWITZ
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 1:111 7TH ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5709
Mailing Address - Country:US
Mailing Address - Phone:212-203-9744
Mailing Address - Fax:408-413-1063
Practice Address - Street 1:111 7TH ST UNIT 111
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5709
Practice Address - Country:US
Practice Address - Phone:212-203-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260273207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty