Provider Demographics
NPI:1598917825
Name:NEOFITOS STEFANIDES M.D., P.C.
Entity Type:Organization
Organization Name:NEOFITOS STEFANIDES M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEOFITOS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-989-8515
Mailing Address - Street 1:100 BROMPTON RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2704
Mailing Address - Country:US
Mailing Address - Phone:718-989-8515
Mailing Address - Fax:718-989-6825
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE L3B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-989-8515
Practice Address - Fax:718-989-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240488-1207X00000X, 207XP3100X, 207XS0106X, 207XS0114X, 207XX0004X, 207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100000158Medicare PIN
NJA100001034Medicare PIN