Provider Demographics
NPI:1952396152
Name:DECRESCENZO, STEPHEN P (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:DECRESCENZO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 BEACH 127TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1730
Mailing Address - Country:US
Mailing Address - Phone:718-474-0843
Mailing Address - Fax:
Practice Address - Street 1:60 BAYLIS RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3838
Practice Address - Country:US
Practice Address - Phone:631-719-2129
Practice Address - Fax:631-756-5114
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist