Provider Demographics
NPI:1669412680
Name:STEVENS, DAVID LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:461 3RD ST
Mailing Address - Street 2:APT#1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2977
Mailing Address - Country:US
Mailing Address - Phone:718-499-7365
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:GOUVERNEUR DEPT. OF MEDICINE 4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-08-20
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Provider Licenses
StateLicense IDTaxonomies
NY196426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400029647Medicare PIN
NYF52894Medicare UPIN
NY013AZ20811Medicare PIN