Provider Demographics
NPI:1821220815
Name:STEPAN, JOVANNA
Entity Type:Individual
Prefix:MS
First Name:JOVANNA
Middle Name:
Last Name:STEPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 STATE ST
Mailing Address - Street 2:3EF
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1242
Mailing Address - Country:US
Mailing Address - Phone:914-907-2357
Mailing Address - Fax:
Practice Address - Street 1:355 STATE ST
Practice Address - Street 2:3EF
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-1242
Practice Address - Country:US
Practice Address - Phone:914-907-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109371363A00000X
NY013401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant