Provider Demographics
NPI:1154523322
Name:TONNESEN, STEPHEN CHRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:TONNESEN
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 1:100 HEMLOCK RD.
Mailing Address - Street 2:2639 GOLD KEY EST.
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9608
Mailing Address - Country:US
Mailing Address - Phone:570-686-3235
Mailing Address - Fax:
Practice Address - Street 1:9002 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4941
Practice Address - Country:US
Practice Address - Phone:718-558-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004314363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical