Provider Demographics
NPI:1942560610
Name:DESIMONE, STEVEN LEWIS (BS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEWIS
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8021
Mailing Address - Country:US
Mailing Address - Phone:917-783-1974
Mailing Address - Fax:
Practice Address - Street 1:47 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-8021
Practice Address - Country:US
Practice Address - Phone:917-783-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist