Provider Demographics
NPI:1649361072
Name:DOUROS, STELLA
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:
Last Name:DOUROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 6TH AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3315
Mailing Address - Country:US
Mailing Address - Phone:718-238-2336
Mailing Address - Fax:718-238-9013
Practice Address - Street 1:7501 6TH AVE
Practice Address - Street 2:1ST FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3315
Practice Address - Country:US
Practice Address - Phone:718-238-2336
Practice Address - Fax:718-238-9013
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189559207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01712418Medicaid
NY01712418Medicaid
NY15B671Medicare PIN