Provider Demographics
NPI:1194762948
Name:HILLER, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:HILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5360 NECONSET HIGHWAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-928-7070
Mailing Address - Fax:631-928-0093
Practice Address - Street 1:5360 NECONSET HIGHWAY
Practice Address - Street 2:SUITE D
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-7070
Practice Address - Fax:631-928-0093
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY112016207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
096749OtherUS HEALTHCARE
4009369OtherTRI CARE
SRH1582071OtherBLUE CROSS BLUE SHIELD
436405OtherAETNA
AJ00600OtherMDNY
OC4637OtherHEALTH NET
1323OtherVYTRA
CS51032OtherOXFORD
096749OtherUS HEALTHCARE