Provider Demographics
NPI:1639498959
Name:RISO, STEPHEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:RISO
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 1:399 LORETTO ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-2202
Mailing Address - Country:US
Mailing Address - Phone:347-635-4461
Mailing Address - Fax:
Practice Address - Street 1:9000 SHORE RD
Practice Address - Street 2:NEW YORK PRESBYTERIAN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5401
Practice Address - Country:US
Practice Address - Phone:718-748-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271041207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine