Provider Demographics
NPI:1902018203
Name:KOBRIN, STEPHEN WAYNE (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:KOBRIN
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 1:3 CHARLOTTES WAY
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-2708
Mailing Address - Country:US
Mailing Address - Phone:914-357-1779
Mailing Address - Fax:203-798-7294
Practice Address - Street 1:100 MAMARONECK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4263
Practice Address - Country:US
Practice Address - Phone:914-357-1779
Practice Address - Fax:203-798-7294
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX9B931Medicare ID - Type UnspecifiedCHIROPRACTIC
NYU76072Medicare UPIN