Provider Demographics
NPI:1396263281
Name:SALVIA, STEPHAN K (FNP)
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:K
Last Name:SALVIA
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:100 HOSPITAL RD STE 216
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8814
Mailing Address - Country:US
Mailing Address - Phone:631-475-5511
Mailing Address - Fax:631-475-5544
Practice Address - Street 1:100 HOSPITAL RD STE 216
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-475-5511
Practice Address - Fax:631-475-5544
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY342167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY342167OtherNEW YORK STATE LICENCE NUMBER