Provider Demographics
NPI:1306873526
Name:ZESZUTEK, STEPHANIE L (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:ZESZUTEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 SAINT STEPHENS PL
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-3208
Mailing Address - Country:US
Mailing Address - Phone:845-987-7800
Mailing Address - Fax:845-987-7811
Practice Address - Street 1:3 SAINT STEPHENS PL
Practice Address - Street 2:SUITE 3
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3208
Practice Address - Country:US
Practice Address - Phone:845-987-7800
Practice Address - Fax:845-987-7811
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY233468207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2600737Medicaid
I19274Medicare UPIN
NY734C6RRTW1Medicare PIN