Provider Demographics
NPI:1649242785
Name:STEFEK, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:STEFEK
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 1:2432 N TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1014
Mailing Address - Country:US
Mailing Address - Phone:607-272-0460
Mailing Address - Fax:607-275-9739
Practice Address - Street 1:2432 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1014
Practice Address - Country:US
Practice Address - Phone:607-272-0460
Practice Address - Fax:607-275-9739
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0690202Medicaid
NYST0608822OtherMEDICARE ID
E84474Medicare UPIN