Provider Demographics
NPI:1679642953
Name:STEPHENS, CHRISTOPHER S (RPAC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:RPAC
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:14 HUDSON AVENU
Practice Address - Street 2:SURGICAL SPECIALISTS OF GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4448
Practice Address - Country:US
Practice Address - Phone:518-926-5600
Practice Address - Fax:518-926-5605
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-08-30
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Provider Licenses
StateLicense IDTaxonomies
NY0103371363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02770038Medicaid
NY02770038Medicaid
NYAA0798Medicare PIN
P97421Medicare UPIN