Provider Demographics
NPI:1205977220
Name:CALLI, STEFANIE L (DC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:CALLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-3544
Mailing Address - Country:US
Mailing Address - Phone:516-377-9090
Mailing Address - Fax:516-378-8793
Practice Address - Street 1:537 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-3544
Practice Address - Country:US
Practice Address - Phone:516-377-9090
Practice Address - Fax:516-378-8793
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3568902OtherTAX ID NUMBER
NYX0B161Medicare PIN