Provider Demographics
NPI:1689880429
Name:STEFANIDES, NEOFITOS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEOFITOS
Middle Name:
Last Name:STEFANIDES
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 1:4401 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE L3B
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3002
Mailing Address - Country:US
Mailing Address - Phone:718-989-8515
Mailing Address - Fax:718-989-6825
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE L3B
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-989-8515
Practice Address - Fax:718-989-6825
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240488-1207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001899Medicare PIN
NYG400001351Medicare PIN
NJA400009110Medicare PIN