Provider Demographics
NPI:1699848739
Name:STEFANICK, GARY F (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:STEFANICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 W 12TH ST
Mailing Address - Street 2:1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8562
Mailing Address - Country:US
Mailing Address - Phone:212-243-3080
Mailing Address - Fax:212-243-0706
Practice Address - Street 1:49 W 12TH ST
Practice Address - Street 2:1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8562
Practice Address - Country:US
Practice Address - Phone:212-243-3080
Practice Address - Fax:212-243-0706
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3773111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX20841Medicare UPIN