Provider Demographics
NPI:1295069318
Name:NENNINGER, STEPHEN MICHAEL (NMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:NENNINGER
Suffix:
Gender:M
Credentials:NMD
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Mailing Address - Street 1:109 RANDALL AVE
Mailing Address - Street 2:NPI MGT
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1638
Mailing Address - Country:US
Mailing Address - Phone:631-235-2111
Mailing Address - Fax:631-551-0204
Practice Address - Street 1:1187 COAST VILLAGE RD
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2737
Practice Address - Country:US
Practice Address - Phone:631-235-2111
Practice Address - Fax:631-540-2345
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2023-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ05-869208D00000X
CA369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice