Provider Demographics
NPI:1639105703
Name:OKON, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:OKON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1780 BROADWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1414
Mailing Address - Country:US
Mailing Address - Phone:212-590-2922
Mailing Address - Fax:212-590-2977
Practice Address - Street 1:140 4TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4901
Practice Address - Country:US
Practice Address - Phone:212-473-2300
Practice Address - Fax:212-473-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
NY2179402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02105195Medicaid
NY02105195Medicaid
H26950Medicare UPIN