Provider Demographics
NPI:1013918853
Name:SHOTEN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SHOTEN
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 1:182 W MONTAUK HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2345
Mailing Address - Country:US
Mailing Address - Phone:631-723-0022
Mailing Address - Fax:631-723-3304
Practice Address - Street 1:182 W MONTAUK HWY
Practice Address - Street 2:SUITE H
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2345
Practice Address - Country:US
Practice Address - Phone:631-723-0022
Practice Address - Fax:631-723-3304
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01365659Medicaid
NYE58211Medicare UPIN
NY01365659Medicaid