Provider Demographics
NPI:1215234760
Name:THE STEPHAN AQUISITION, LLC
Entity type:Organization
Organization Name:THE STEPHAN AQUISITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:716-875-1113
Mailing Address - Street 1:1025 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2925
Mailing Address - Country:US
Mailing Address - Phone:716-875-1113
Mailing Address - Fax:716-873-5557
Practice Address - Street 1:5375 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2823
Practice Address - Country:US
Practice Address - Phone:716-748-7397
Practice Address - Fax:716-748-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies