Provider Demographics
NPI:1831331388
Name:MASSIMI, STEPHEN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:MASSIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0626
Mailing Address - Country:US
Mailing Address - Phone:203-705-2350
Mailing Address - Fax:203-705-2924
Practice Address - Street 1:1 BLACHLEY RD
Practice Address - Street 2:HOSPITAL FOR SPECIAL SURGERY
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-0002
Practice Address - Country:US
Practice Address - Phone:203-705-2350
Practice Address - Fax:203-705-2924
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255564208100000X, 2081S0010X
CT52074208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine