Provider Demographics
NPI:1700137379
Name:BAZYLEWICZ, STEPHANIE C (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:C
Last Name:BAZYLEWICZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:CORSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 E 17TH ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-598-3889
Mailing Address - Fax:212-598-6015
Practice Address - Street 1:301 E 17TH ST
Practice Address - Street 2:SUITE 1402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-598-3889
Practice Address - Fax:212-598-6015
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015976-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical