Provider Demographics
NPI:1053396192
Name:STEPHENS, DANIEL (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 ROUTE 22
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5948
Mailing Address - Country:US
Mailing Address - Phone:845-279-2323
Mailing Address - Fax:845-278-2115
Practice Address - Street 1:2050 ROUTE 22
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5948
Practice Address - Country:US
Practice Address - Phone:845-279-2323
Practice Address - Fax:845-278-2115
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00932783Medicaid
NYQ07990Medicare UPIN
NY5231L06761Medicare PIN