Provider Demographics
NPI:1659483378
Name:SILLS, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:SILLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:317 S MANNING BLVD
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1738
Mailing Address - Country:US
Mailing Address - Phone:518-489-8409
Mailing Address - Fax:518-482-5162
Practice Address - Street 1:317 S MANNING BLVD
Practice Address - Street 2:SUITE # 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1738
Practice Address - Country:US
Practice Address - Phone:518-489-8409
Practice Address - Fax:518-482-5162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY090817-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00515095Medicaid
NY31922BMedicare ID - Type Unspecified
B79432Medicare UPIN