Provider Demographics
NPI:1881251692
Name:DR STEPHEN M ESTNER PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR STEPHEN M ESTNER PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-275-2225
Mailing Address - Street 1:875 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-6024
Mailing Address - Country:US
Mailing Address - Phone:401-275-2225
Mailing Address - Fax:401-275-0620
Practice Address - Street 1:875 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-6024
Practice Address - Country:US
Practice Address - Phone:401-275-2225
Practice Address - Fax:401-275-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty