Provider Demographics
NPI:1659312726
Name:KING, STEFENIE (MD)
Entity Type:Individual
Prefix:
First Name:STEFENIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ISLAND COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612
Mailing Address - Country:US
Mailing Address - Phone:585-368-6000
Mailing Address - Fax:585-368-6010
Practice Address - Street 1:500 ISLAND COTTAGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612
Practice Address - Country:US
Practice Address - Phone:585-368-6000
Practice Address - Fax:585-368-6010
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670877Medicaid
NYRA7692- GRP:BA0017Medicare PIN
NY02670877Medicaid
NY02670877Medicaid