Provider Demographics
NPI:1881916906
Name:DEMAIO, STEPHEN JOHN
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:DEMAIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3631
Mailing Address - Country:US
Mailing Address - Phone:631-265-7888
Mailing Address - Fax:631-265-6935
Practice Address - Street 1:14 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3631
Practice Address - Country:US
Practice Address - Phone:631-265-7888
Practice Address - Fax:631-265-6935
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist