1497740815 NPI number — STEPHEN M MENITOVE MD

Table of content: STEPHEN M MENITOVE MD (NPI 1497740815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497740815 NPI number — STEPHEN M MENITOVE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENITOVE
Provider First Name:
STEPHEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497740815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 GRAND ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10990-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-987-3952
Provider Business Mailing Address Fax Number:
845-987-5979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CROSFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 318
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-353-5600
Provider Business Practice Location Address Fax Number:
845-353-5668
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  1347601 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0020680 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "FAM HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HUDSON HEALTH PLAN MCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "CIGNA HMO POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00707906 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0D0736 . This is a "HEALTHNET OF THE NORTHEAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123214 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HORIZON HEALTHCARE OF NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "INDECS ORANGE ULSTER SCHL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 358401 . This is a "BCBS EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "FEDELIS MEDICAID HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "LOCAL 1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "BEECH STREET NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 132995699 . This is a "HEATLH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2900091 . This is a "GHI ALL PLANS EXCEPT HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4229785 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X139P . This is a "HIP" identifier . This identifiers is of the category "OTHER".




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