Provider Demographics
NPI:1609153519
Name:GEORGE R. STEFANOS M.D. P.C
Entity Type:Organization
Organization Name:GEORGE R. STEFANOS M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEFANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-349-1146
Mailing Address - Street 1:21 UNION HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1965
Mailing Address - Country:US
Mailing Address - Phone:585-349-1146
Mailing Address - Fax:
Practice Address - Street 1:21 UNION HILL DR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1965
Practice Address - Country:US
Practice Address - Phone:585-349-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01754470Medicaid